High-dose online hemodiafiltration,
does it really help with Reduced all-cause mortality versus high-flux hemodialysis in maintenance dialysis?
research showsThe grade is B. CONVINCE randomized 1,360 participants, 683 to high-dose hemodiafiltration and 677 to high-flux hemodialysis. Over a median 30 months, 118 (17.3%) versus 148 (21.9%) died, HR 0.77 (95% CI 0.65 to 0.93). ESHOL independently pointed in the same direction, with an all-cause mortality HR of 0.70 (0.53 to 0.92). ESHOL was partly supported by Fresenius Medical Care and Gambro, whereas CONVINCE was supported by EU Horizon 2020 grant 754803, and the investigator groups had no authors in common. The score is 76.
ads claimHigh dose means achieved convection volume, not merely selecting a machine setting. Vascular access, blood flow, and treatment time determine whether the target is reached.
Useful facts when choosing a product
- CONVINCE targeted at least 23 L per session and achieved a mean 25.3 L.
- ESHOL was partly supported by Fresenius Medical Care and Gambro, whereas CONVINCE received EU Horizon 2020 grant 754803; the investigator groups had zero authors in common.
- Modality changes require specialist assessment of access, blood flow, blood pressure, and treatment time.
What the research actually shows
ESHOL randomized 906 Spanish maintenance-hemodialysis patients and reported all-cause mortality HR 0.70 (0.53 to 0.92). CONVINCE randomized 1,360 patients at 61 centers in eight European countries and reported 118/683 versus 148/677 deaths, HR 0.77 (0.65 to 0.93). ESHOL was partly supported by Fresenius Medical Care and Gambro, whereas CONVINCE received EU Horizon 2020 grant 754803; the investigator groups had zero authors in common. Both papers are included in citations, satisfying independent replication. Survival follow-up was nevertheless incomplete for 355 of 906 ESHOL participants (39%), with survival censored at treatment discontinuation.
Why this is classified as B (76)
Two large randomized trials with different investigators and funders replicated lower mortality. However, survival follow-up was incomplete for 355 of 906 ESHOL participants (39%), with survival censored at discontinuation, giving B with 76 points.
Counterpoint. This verdict applies to patients able to achieve at least 23 L per session and should not be generalized to lower-dose or different dialysis schedules.
Rejudgment record. Cross-check applied — ESHOL and CONVINCE were compared for population, intervention, control, mortality endpoint, authorship, funding, and follow-up using papers and registrations
| Endpoint | H | Hard endpoint - actual events such as death |
| Replication | R2 | Independently replicated across trials |
| Independence | I1 | Mixed funding sources |
| Effect size | E+ | Meets the clinically important threshold |
The scoring table and the verdict agree (B).
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Reduced all-cause mortality | B | CONVINCE and ESHOL pointed in the same direction and had distinct investigator groups and funders, qualifying as independent replication. |
| Reduced cardiovascular events | D | CONVINCE reported HR 1.07 (0.86 to 1.33) for fatal or nonfatal cardiovascular events. |
Cross-check — Codex and Claude
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| Study 1 | Spanish multicenter randomized clinical trial | 906 | Partly supported by grants from Fresenius Medical Care and Gambro through the Catalan Society of Nephrology; disclosures: none | Primary all-cause mortality outcome | All-cause mortality HR 0.70 (95% CI 0.53 to 0.92) | Large hard-outcome replication trial with investigators and funding distinct from CONVINCE; survival follow-up was incomplete for 355/906 (39%) and censored at discontinuation |
| Study 2 | Multinational pragmatic randomized clinical trial | 677 | European Union Horizon 2020 Research and Innovation Programme, grant 754803 | Primary all-cause mortality outcome | 118/683 (17.3%) versus 148/677 (21.9%), HR 0.77 (0.65 to 0.93) | Pivotal publicly funded large hard-outcome trial |
Receipt — 2 References
All 2 cited sources were verified for existence at the original page (as of 2026-08-15).
Reviewed and approved: Chamgap Editorial Team · Approval date: 2026-08-15 · Corrections: none
Cite this verdict
[Chamgap] High-dose online hemodiafiltration x reduced all-cause mortality in maintenance dialysis — Evidence Grade B·76. 2 cited sources checked. Source: https://chamgap.com/en/verdicts/energy/high-dose-online-hemodiafiltration-all-cause-mortality/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
What this document does and does not do
Chamgap is an information source. It reports what research has and has not confirmed; it does not tell readers what to take or buy. That decision belongs to readers and, when needed, medical or legal professionals. This verdict reflects literature available up to the search date and may change as new research appears. Nothing here is medical advice.