In the CONVINCE trial, the primary analysis demonstrated a survival benefit for patients receiving high-dose hemodiafiltration (HDF) as compared with high-flux hemodialysis (HD). A secondary objective was to evaluate effects on health-related quality of life (HRQoL); assessed in eight domains (physical function, cognitive function, fatigue, sleep disturbance, anxiety, depression, pain interference, social participation) applying instruments from the Patient-Reported Outcome Measurement Information System (PROMIS) before randomization and every three months thereafter. In total 1360 adults with dialysis-dependent chronic kidney disease, eligible to receive high-flux HDF (23 liters or more), were randomized (1:1); 84% response rate to all questionnaires. Both groups reported a continuous deterioration in all HRQoL domains. Overall, raw score changes from baseline were more favorable in the HDF group, resulting in a significant omnibus test after a median observation period of 30 months. Most relevant single raw score differences were reported for cognitive function. Patients receiving HDF reported a decline of -0.95 units (95% confidence interval - 2.23 to +0.34) whereas HD treated patients declined by -3.90 units (-5.28 to - 2.52). A joint model, adjusted for mortality differences, utilizing all quarterly assessments, identified a significantly slower HRQoL decline in physical function, cognitive function, pain interference, and social participation for the HDF group. Their physical health summary score declined -0.46 units/year slower compared to the HD group. Thus, the CONVINCE trial showed a beneficial effect of high-dose hemodiafiltration for survival as well as a moderate positive effect on patients’ quality of life, most pronounced with respect to their cognitive function.

中文翻译：

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CONVINCE 随机试验发现，接受血液透析滤过治疗的慢性肾病患者的生活质量有积极影响


在 CONVINCE 试验中，初步分析表明，与高通量血液透析 （HD） 相比，接受高剂量血液透析滤过 （HDF） 的患者具有生存获益。次要目标是评估对健康相关生活质量 （HRQoL） 的影响;在随机分组前和此后每三个月应用患者报告结果测量信息系统 （PROMIS） 中的工具在八个领域（身体机能、认知功能、疲劳、睡眠障碍、焦虑、抑郁、疼痛干扰、社会参与）进行评估。共有 1360 名符合接受高通量 HDF（23 升或更多）条件的透析依赖性慢性肾病成人患者被随机分组 （1：1）;对所有问卷的回复率为 84%。两组均报告所有 HRQoL 域持续恶化。总体而言，HDF 组的原始评分相对于基线的变化更有利，导致在中位观察期 30 个月后进行了显着的综合测试。报告了认知功能最相关的单个原始分数差异。接受 HDF 的患者报告下降了 -0.95 个单位 （95% 置信区间 - 2.23 至 +0.34），而接受 HD 治疗的患者下降了 -3.90 个单位 （-5.28 至 - 2.52）。一个联合模型，根据死亡率差异进行调整，利用所有季度评估，确定 HDF 组的身体机能、认知功能、疼痛干扰和社会参与的 HRQoL 下降速度显着减慢。与 HD 组相比，他们的身体健康总分下降了 -0.46 个单位/年。 因此，CONVINCE 试验显示，高剂量血液透析滤过对生存有益，对患者的生活质量有中等程度的积极影响，在他们的认知功能方面最为明显。