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Introduction: High convection volumes in hemodiafiltration (HDF) result in improved survival; however, it remains unclear whether it is achievable in all patients. Methods: CONVINCE, a randomized controlled trial, randomized patients with end-stage kidney disease 1:1 to high-dose HDF versus high-flux hemodialysis (HD) continuation. We evaluated the proportion of patients achieving high-dose HDF target: convection volume per visit of ≥23 l (range ±1 l) at baseline, month 3, and month 6. We compared baseline characteristics in the following 2 ways: (i) patients on target for all 3 visits versus patients who missed target on ≥1 visits and (ii) patients on target for all 3 visits or missing it once versus patients who missed target on ≥2 visits. Results: A total of 653 patients were randomized to HDF. Their mean age was 62.2 (SD 13.5) years, 36% were female, 81% had fistula vascular access, and 33% had diabetes. Across the 3 visits, 75 patients (11%), 27 patients (4%), and 11 patients (2%) missed the convection volume target once, twice, and thrice, respectively. Apart from diabetes, there were no apparent differences in patient characteristics between patients who always achieved the high-dose target (83%) and those who missed the target either once or more (17%) or twice or more (6%). Conclusion: Achieving high-dose HDF is feasible for nearly all patients in CONVINCE and could be maintained during the 6-month follow-up period. Apart from diabetes, there were no other indications for confounding by indication on multivariable analyses that may explain the potential survival advantage for patients receiving high-dose HDF.
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BACKGROUND: There is evidence for beneficial effects of lipoprotein apheresis (LA) in terms of reduction of cardiovascular events and interventions, but quality of life (QOL) in LA patients has only been explored in small samples. OBJECTIVE: In this study, both LA- or treatment-related and health-related QOL (HRQOL) were assessed in 206 LA patients. METHODS: Mental and physical HRQOL of the LA patients was assessed by means of the SF-12 as well as the EQ-5D. Physical complaints were assessed by the Patient Health Questionnaire-15 and LA- or treatment-related QOL by the Apheresis Quality of Life Form, developed for this study. RESULTS: Comparison with general population norms showed that LA patients scored significantly lower on HRQOL and significantly higher on physical complaints. A higher perceived impact of the treatment proved to have a significant negative association with HRQOL and a positive one with physical complaints. CONCLUSION: Previous studies reported higher levels of QOL in LA patients. This study showed that treatment-related QOL contributes to HRQOL and physical complaints in LA patients. While many patients do not experience LA as a real burden and report positive effects of the treatment, there is also an important group of patients for whom this is not the case. Although the impact on QOL of LA patients does most probably not outweigh the cardiovascular benefits of the treatment, it is important to screen treatment-related QOL in LA patients to optimize care in a personalized way. Future research is needed to compare QOL in LA with non-LA patients with similar medical conditions.
