PATIENT-REPORTED INTER- AND INTRADIALYTIC SYMPTOMS IN HEMODIALYSIS AND HEMODIAFILTRATION PATIENTS - ANALYSIS FROM THE CONVINCE TRIAL

 

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PATIENT-REPORTED INTER- AND INTRADIALYTIC SYMPTOMS IN HEMODIALYSIS AND HEMODIAFILTRATION PATIENTS - ANALYSIS FROM THE CONVINCE TRIAL

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Ngoc Pham ngoc.pham@freseniusmedicalcare.com Fresenius Medical Care Global Medical Office Bad Homburg Germany * Charite Center for Patient-Centered Outcomes Research Berlin Germany
Krister Cromm krister.cromm@freseniusmedicalcare.com Fresenius Medical Care Global Medical Office Bad Homburg Germany - Charite Center for Patient-Centered Outcomes Research Berlin Germany
Yan Zhang yan.zhang@freseniusmedicalcare.com Fresenius Medical Care Global Medical Office Bad Homburg Germany -
Ana Catalina Alvarez Elias anacatalina.alvarezelias@rriny.com Fresenius Medical Care Global Medical Office New York City United States -
Saynab Atiye saynab.atiye@freseniusmedicalcare.com Fresenius Medical Care Global Medical Office Bad Homburg Germany -
Anna Schappert anna.schappert@charite.de Charite Center for Patient-Centered Outcomes Research Berlin Germany -
Gregor Liegl gregor.liegl@charite.de Charite Center for Patient-Centered Outcomes Research Berlin Germany -
Kathrin Fischer kathrinfischer85@gmail.com Charite Center for Patient-Centered Outcomes Research Berlin Germany -
Felix Fischer felix.fischer@charite.de Charite Center for Patient-Centered Outcomes Research Berlin Germany -
Matthias Rose matthias.rose@charite.de Charite Center for Patient-Centered Outcomes Research Berlin Germany -
Giovanni Strippoli gfmstrippoli@gmail.com University of Bari Department of Precision and Regenerative Medicine and Ionian Area Bari Italy - University of Sydney School of Public Health Sydney Australia
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Patients on dialysis experience a wide range of symptoms during and between dialysis sessions that negatively affect their well-being. Addressing these symptoms, particularly from the patient’s perspective, is a crucial component in the treatment. We investigated the differences in symptom severity between hemodialysis and hemodiafiltration patients involved in the CONVINCE randomized trial. 

The CONVINCE study was an international randomized controlled trial comparing high-dose hemodiafiltration with high-flux hemodialysis. Symptoms were assessed using a customized questionnaire based on the symptoms subscale of the Kidney Disease Quality of Life Instrument-36 (KDQOL-36). It was expanded with additional items to cover both inter- and intradialytic symptoms. Scores range from 0 to 100, with higher scores indicating fewer symptoms. Data were collected at baseline and quarterly for up to 12 months.  Prevalence and scores of all inter- and intradialytic symptom items at baseline and during follow-up visits were assessed and compared between hemodialysis and hemodiafiltration groups. In this randomized comparison, changes in symptom scores over time were analyzed using Mixed Models for Repeated Measures at the p < .05 level.

Among 683 patients treated with hemodiafiltration and 677 patients treated with hemodialysis, a significant treatment effect was observed, with hemodiafiltration patients reporting less problems with appetite than hemodialysis patients (p = 0.029). A significant treatment x time interaction was observed for dry skin (p = 0.015): At baseline, scores for dry skin were similar between groups, but from 6 months onward, hemodiafiltration patients consistently reported fewer problems with dry skin than hemodialysis patients (p < 0.05 at 6, 9 and 12 months). Mean scores and standard deviations for lack of appetite and dry skin are illustrated in the figures below. Symptom burden for all other symptoms fluctuated across visits regardless of treatment, however, no further significant differences were found between treatment groups. 

We found that hemodiafiltration reduced lack of appetite and dry skin, two symptoms closely related to patients’ quality of life. Symptom management in dialysis is complex and future research should further explore the potential benefits of hemodiafiltration and refine patient-reported outcome tools to better capture patient perception and guide personalized treatment strategies.

Kewords