September 2023 Issue 09 www.renalinterventions.net
In this issue:
FDA update lowers red flag on paclitaxel
ESKD Summit summarised
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The publication in The New England Journal of Medicine (NEJM) of new research on haemodiafiltration comes following a series of inconclusive prior studies. Lead author Peter J Blankestijn (University Medical Center Utrecht, Utrecht, The Netherlands) and colleagues note that previous trials and study-level meta-analyses have not resolved the “uncertainty” around the therapy’s ability to provide better outcomes for end-stage kidney disease (ESKD) patients, despite differences in practice across continents. Their pragmatic, open-label, randomised, controlled trial (RCT) now offers further clarity on haemodiafiltration’s survival benefit compared with conventional haemodialysis.
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Kate Steiner page 14
EVA evaluated page 24
“Take time to connect”: Patient perspectives and mental impact in the spotlight
Haemodiafiltration mortality risk found lower than haemodialysis
IN FOUR PREVIOUS RCTS COMPARing the two treatments, only one—that of Francisco Maduell (University of Barcelona, Barcelona, Spain) et al in the Journal of the American Society of Nephrology (JASN) in 2013—found a statistically significant survival advantage for haemodiafiltration, Blankestijn et al note. These trials also saw the raising of “concerns about attrition” by “observers in the scientific and nephrology communities”, the authors state. With the need for more data in mind, the study authors designed the CONVINCE trial, in which 1,360 patients underwent randomisation at 61 centres across eight European countries. Of these, 683 patients were assigned to a group receiving highdose haemodiafiltration while 677 received high-flux haemodialysis. All patients were aged ≥18 years and had a kidney failure diagnosis, and were candidates for high-dose haemodiafiltration, meaning “a convection volume of ≥23l in postdilution mode per session”. Among the exclusion criteria were “severe non-adherence” to dialysis and prescriptions as well as a life expectancy of less than three months, previous haemodiafiltration less than 90 days before screening and expectation of kidney transplant within six months of screening. The trial’s primary outcome was identified as all-cause mortality, while secondary outcomes included cause-specific mortal-
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a treatment into their lives. Connect mentally with patients, because what they are going through is shocking—every time. It is not easy for anyone,” she said. Speaking elsewhere to Renal Interventions, Papageorgiou expanded on her personal experience. “The fact that it happened at a very young age made it especially difficult for me to process. Everything had to happen very quickly to ‘fix it’ […] and when you are not given that time, it affects you mentally. “I wish medicine could find a better way to do dialysis—to give [patients] fewer restrictions, let them be able to travel, to just make them feel better in between sessions. It is a lifeline, but what kind of life is that?” On her experience at EVA, she was upbeat. “Coming in, I was not exactly sure how [the physicians attending] would feel about me being sentimental and talking about the mental impact. But I am glad that I did—I see that the response was great, and I hope that it does help them in the long term to help others feel more understood.” Another patient representative who featured as a speaker at EVA 2023 was West, who spoke to Jaffer on his 27-year experience living with chronic kidney disease (CKD). After an initial IgA nephropathy diagnosis in 1996, he said, he received a kidney transplant that year. He has also undergone both in-centre and home apageorgiou’s journey with haemodialysis. kidney disease, which has West highlighted the comorbidities associencompassed pre-dialysis care, ated with his diagnosis and treatment, includdialysis, and multiple kidney ing heart disease and a triple heart bypass, transplantations, began at age 23 skin cancer from immunosuppressants, and bone Vivian with a diagnosis of IgA nephropathy. Drawing on disease from calcification breakdown. Jaffer noted Papageorgiou that experience, Papageorgiou, asked what could that, given the frequent focus on kidney disease have improved it, said: “As patients, we understand that itself, these accompanying conditions were somedoctors have little to no time to sit down and connect times apportioned less consideration. individually with each and every patient, but “It is a long journey,” West said. Echoing I do believe that just a few moments of their Papageorgiou’s comments on CKD’s mental time would have a very positive impact on the impact, he said: “Not only [because of ] those patient’s outlook and mental wellbeing during physical conditions, but the mental aspects this tumultuous time. as well. It can be very tiring—there is a lot “Firstly, [it would help] to take the time to to do, particularly if you do home dialysis, explain to them exactly what is happening to for you and for your family. I have a fantastheir bodies and why—should there be a clear tic support team behind me, but the thing diagnosis—and then to be presented with their that stands out for me now is the mental factor. possible treatment options in a way that would best Phil West I would like, if possible, to see more support and suit each patient given their background and lifestyle.” understanding for this part of the disease.” She added that “graphs and statistics are black and white, but you need to talk to patients about how best to fit Continued on page 2
A renal disease diagnosis is “a shock at any age”, and its “huge impact” on the lives of patients and their families is something that takes time to process. Doctors should engage better with patients and help to talk them through the experience—that was the message from Vivian Papageorgiou, a patient representative at the recent Endo Vascular Access (EVA) Meeting (23–24 June, Patras, Greece) who spoke to Nicholas Inston (Queen Elizabeth Hospital Birmingham, Birmingham, UK) to describe her experience of kidney disease and the host of treatment modalities she has undergone. The patient experience was also painted vividly by Phil West in conversation with Ounali Jaffer (Royal London Hospital, London, UK).
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