Background: Evidence for a survival benefit of hemodiafiltration (HDF) over high-flux hemodialysis (HD) largely comes from studies based on prevalent end-stage kidney disease (ESKD) patients with longer dialysis exposure. In contrast, the effect of HDF on mortality of incident patients-those newly starting dialysis-remains less well understood. Methods: We analyzed data from 18,515 incident patients (dialysis vintage <3 months) treated between 2019 and 2022 at Fresenius Medical Care NephroCare Clinics. Patients were classified as HDF or HD based on their predominant dialysis modality during the first year of follow-up (≥75% of sessions). To assess the effect of HDF on early phase after treatment initiation, follow-up was limited to two years. Cox proportional hazards models with inverse probability of treatment weighting (IPTW) were applied to estimate all-cause and cardiovascular (CVD) mortality risk. Results: Baseline characteristics between HDF and HD groups were comparable after IPTW. Over a median follow-up of 15.7 months (IQR, 6.4 -24.0 months), HDF was associated with a lower risk of all-cause mortality compared to HD (11.7 vs. 15.6 per 100 person-years; hazard ratio HR, 0.80; 95% CI, 0.75–0.86). Furthermore, HDF was associated with a lower risk of CVD mortality compared to HD (4.1 vs. 6.7 per 100 person-years; HR, 0.71; 95% CI, 0.63–0.80). Conclusions: In the large real-world cohort of incident ESKD patients who are in early phase of dialysis treatment, online HDF was associated with a significant survival advantage compared to conventional HD. These findings reinforce the potential clinical benefits of HDF and support early adoption of HDF upon dialysis initiation.
Zhang et al. (Thu,) studied this question.