Clinical journal of the American Society of Nephrology
14 May 2026 Hemodialysis Modality and Mortality Outcomes among Incident Dialysis Patients: An International Cohort Study Comparing High-Volume Hemodiafiltration and HemodialysisRESULTSBaseline characteristics between HDF and HD groups were comparable after IPTW. Over a median follow-up of 15.7 months (IQR, 6.4 -24.0 months), HDF was associated with a lower risk of all-cause mortality compared to HD (11.7 vs. 15.6 per 100 person-years; hazard ratio [HR], 0.80; 95% CI, 0.75-0.86). Furthermore, HDF was associated with a lower risk of CVD mortality compared to HD (4.1 vs. 6.7 per 100 person-years; HR, 0.71; 95% CI, 0.63-0.80).CONCLUSIONSIn the large real-world cohort of incident ESKD patients who are in early phase of dialysis treatment, online HDF was associated with a significant survival advantage compared to conventional HD. These findings reinforce the potential clinical benefits of HDF and support early adoption of HDF upon dialysis initiation.BACKGROUNDEvidence for a survival benefit of hemodiafiltration (HDF) over high-flux hemodialysis (HD) largely comes from studies based on prevalent end-stage kidney disease (ESKD) patients with longer dialysis exposure. In contrast, the effect of HDF on mortality of incident patients-those newly starting dialysis-remains less well understood.METHODSWe analyzed data from 18,515 incident patients (dialysis vintage <3 months) treated between 2019 and 2022 at Fresenius Medical Care NephroCare Clinics. Patients were classified as HDF or HD based on their predominant dialysis modality during the first year of follow-up (≥75% of sessions). To assess the effect of HDF on early phase after treatment initiation, follow-up was limited to two years. Cox proportional hazards models with inverse probability of treatment weighting (IPTW) were applied to estimate all-cause and cardiovascular (CVD) mortality risk.
