Exploring Adequacy Parameters and Survival Patterns in a Brazilian Cohort Undergoing Hemodiafiltration

Background: Recent evidence suggests a survival benefit of hemodiafiltration compared to conventional hemodialysis. We aimed to analyze the baseline characteristics and survival patterns among patients undergoing hemodiafiltration in a real-world scenario. Methods: We included a cohort of patients undergoing hemodiafiltration therapy at the NefroStar clinics, ranging from October 2018 to May 2023. We retrieved baseline patient characteristics, the dialysis access method, monthly biochemical exams classified in Kidney Disease Outcomes Quality Initiative (KDOQI) bundles, hospitalization rate, and the follow-up data. Results: We analyzed a cohort of 223 patients who exclusively underwent hemodiafiltration. The mean convective volume was 67±30 liters per week. The majority of patients achieved the KDOQI-recommended bundles, ranging from 70% for phosphorus to 87% for potassium. The majority of hospitalizations were attributed to vascular access complications, ranging from 2.4% to 15.9%, followed by cardiovascular issues (5.3% to 9.9%) and clinical hospitalization (1.4% to 8.4%). The incidence of catheter-related bloodstream infectious density ranged from 0.02 to 0.1 per 1000 catheters per day. Univariate Kaplan-Meier analysis revealed survival rates for hemodiafiltration at 180 days, with a rate of 93% (90 – 97%), at 730 days, a rate of 83% (77-90%), and at 1095 days, a rate of 73% (63-83%). Conclusion: We showed significantly lower rates of hospitalization, fewer catheter-related bloodstream infections, and reduced mortality in a real-world cohort of hemodiafiltration patients. These factors warrant further in-depth investigation, particularly with the aim of mitigating mortality rates in the Brazilian dialysis population.