Kidney International
Economic Evaluation of the CONVINCE Trial: High-Dose Online Hemodiafiltration vs. High-Flux Hemodialysis
Chronic kidney disease patients undergoing dialysis often receive either high-flux hemodialysis (HD) or high-dose online hemodiafiltration (HDF). Emerging clinical evidence has indicated that HDF may offer a survival advantage over HD by reducing all-cause mortality. However, questions remain regarding the cost-effectiveness of implementing HDF on a larger scale.
This health economic analysis, derived from the multinational, randomized controlled CONVINCE trial, assessed the cost-utility of HDF compared to HD across various countries and health systems. While the per-treatment cost of HDF was marginally higher, patients treated with HDF showed a measurable increase in quality-adjusted life years (QALYs), suggesting improved long-term outcomes and quality of life.
Overall, the findings point to HDF as a potentially cost-effective alternative to HD. However, healthcare systems considering adoption should carefully weigh regional economic factors, healthcare infrastructure, and patient population needs before revising dialysis protocols on a national or institutional level.
Kidney International Reports
A 20-Year Retrospective on Kidney Transplantation in Iran: Transition Toward a Deceased-Donor Model
Over the past two decades, Iran has undergone a substantial transformation in its national approach to kidney transplantation. Historically reliant on compensated living unrelated kidney donation, the country has made significant progress in promoting deceased-donor transplants, which now constitute approximately 72% of all kidney transplants.
This shift has been made possible through a series of strategic and culturally informed measures. The foundation was laid in 1989 with a religious decree permitting organ donation from deceased individuals, followed by supportive legislation in 2000. Public education campaigns led by the Iranian Society of Organ Donation further reinforced acceptance of deceased organ donation, improving societal attitudes and participation.
Enhanced transparency, improvements in donor identification, and better procurement systems have contributed to the success of this transition. Despite these advancements, a substantial gap remains—nearly 10,000 kidney transplants are still needed each year to meet national demand.
Iran’s evolving model highlights the impact of policy, public engagement, and religious guidance in shaping transplant medicine. It serves as a potential blueprint for other countries aiming to strengthen their deceased-donor programs while addressing ethical concerns surrounding compensated donation.