Journal
CLINICAL KIDNEY JOURNAL
Volume 15, Issue 10, Pages 1924-1931Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ckj/sfac153
Keywords
haemodiafiltration; haemodialysis; treatment effect heterogeneity; treatment effect prediction
Categories
Funding
- EuDial working group
- European Nephrology and Dialysis Institute
- Catalan Society of Nephrology
- Fresenius Medical Care and Gambro through the Catalan Society of Nephrology
- Dutch Kidney Foundation (Nierstichting Nederland) [C02.2019]
- Fresenius Medical Care, Netherlands
- Gambro Lundia AB, Sweden
- Dr E.E. Twiss Fund
- Roche Netherlands
- International Society of Nephrology/Baxter Extramural Grant Program
- Netherlands Organization for Health Research and Development (ZONMw) [170882802]
- Health Ministry (Programme Hospitalier de Recherche Clinique, PHRC)
- CONVINCE study (European Union) [754803]
- H2020 Societal Challenges Programme [754803] Funding Source: H2020 Societal Challenges Programme
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This study developed a treatment effect prediction model to determine which patients would benefit most from haemodiafiltration compared with haemodialysis in terms of all-cause mortality, using readily available patient and disease characteristics.
Background Previous studies suggest that haemodiafiltration reduces mortality compared with haemodialysis in patients with end-stage kidney disease (ESKD), but the controversy surrounding its benefits remains and it is unclear to what extent individual patients benefit from haemodiafiltration. This study is aimed to develop and validate a treatment effect prediction model to determine which patients would benefit most from haemodiafiltration compared with haemodialysis in terms of all-cause mortality. Methods Individual participant data from four randomized controlled trials comparing haemodiafiltration with haemodialysis on mortality were used to derive a Royston-Parmar model for the prediction of absolute treatment effect of haemodiafiltration based on pre-specified patient and disease characteristics. Validation of the model was performed using internal-external cross validation. Results The median predicted survival benefit was 44 (Q1-Q3: 44-46) days for every year of treatment with haemodiafiltration compared with haemodialysis. The median survival benefit with haemodiafiltration ranged from 2 to 48 months. Patients who benefitted most from haemodiafiltration were younger, less likely to have diabetes or a cardiovascular history and had higher serum creatinine and albumin levels. Internal-external cross validation showed adequate discrimination and calibration. Conclusion Although overall mortality is reduced by haemodiafiltration compared with haemodialysis in ESKD patients, the absolute survival benefit can vary greatly between individuals. Our results indicate that the effects of haemodiafiltration on survival can be predicted using a combination of readily available patient and disease characteristics, which could guide shared decision-making.
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