#3664 BRIGHT-HD—Brazil research investigation on public health gain comparing survival between hemodialysis and hemodiafiltration

Abstract Background and Aims High-flux online hemodiafiltration (OL-HDF) appears to be associated with better survival than hemodialysis (HD). In Brazil, OL-HDF is only affordable for patients with private health insurance. Although observational studies have shown a survival advantage with OL-HDF, even in Brazil, it is unclear whether this benefit would apply to patients without private health insurance. We compared overall and cardiovascular mortality between OL-HDF and HD in patients treated exclusively by the Public Health Care system. Method This is an observational cohort study that included adult patients on maintenance dialysis between September 1st, 2022 and December 1st, 2024. The main outcome was all-cause mortality. Secondary outcome was cardiovascular mortality. Fine-gray sub-distribution hazard models were used to evaluate survival in the presence of a competing event (kidney transplant and recovery of renal failure). Results Patients on HD (n = 321) and OL-HDF (n = 48) were similar in age, race, sex and vascular access. Patients on HD were more likely to have diabetes (54.0% vs. 29.2%, P = 0.001) and underwent higher hours/week on dialysis (11.2 ± 1.8 vs. 10.5 ± 1.6 h, P = 0.006). In an adjusted Fine and Gray model, the hazard of death for patients on OL-HDF was 68% lower than that for patients on HD and the risk of death in patients with an arteriovenous fistula was 55% lower compared to patients to those with a catheter (Fig. 1). Cardiovascular mortality was not different among groups. Conclusion These findings indicate that OL-HDF is associated with higher overall survival compared to HD, even for patients without private health insurance.