Photo Credit: Akiromaru

The following is of “Effect of hemodiafiltration and hemodialysis on mortality of patients with end-stage kidney disease: a meta-analysis,” published in the October 2024 issue of Nephrology by Zhu et al. 

Previous randomized controlled trials (RCTs) and meta-analyses show conflicting evidence on hemodiafiltration impact on mortality in patients with end-stage renal disease (ESRD). 

Researchers conducted a prospective study to compile the latest evidence on hemodiafiltration impact on mortality in patients with ESRD. 

They systematically searched PubMed, Embase, and the Cochrane Library for RCTs until January 14, 2024. Relevant data were analyzed using Review Manager 5.3 software to evaluate the quality of evidence. 

The results showed that the study included 10 RCTs with 4,654 people living with long-term dialysis. Hemodiafiltration reduced all-cause mortality (relative risk [RR] 0.84, 95% CI 0.72–0.99, P = 0.04) and cardiovascular mortality (RR 0.74, 95% CI 0.61–0.90, P = 0.002) compared to hemodialysis. However, it did not affect sudden death (RR 0.92, 95% CI 0.64–1.34, P = 0.68) or infection-related mortality (RR 0.70, 95% CI 0.47–1.03, P = 0.07). Subgroup analysis showed HDF was superior to high-flux hemodialysis for all-cause mortality (RR 0.81, 95% CI 0.69–0.96, P = 0.01) but not to low-flux hemodialysis (RR 0.93, 95% CI 0.77–1.12, P = 0.44). Hemodiafiltration with a convection volume of 22 L or more reduced all-cause and cardiovascular mortality (RR 0.76, 95% CI 0.65–0.88, P = 0.0002; RR 0.73, 95% CI 0.54–0.94, P = 0.01). 

The study concluded that hemodiafiltration leads to better outcomes for patients with end-stage renal disease, particularly a reduction in overall mortality and cardiovascular mortality. Of note, this benefit seems to be more pronounced for patients receiving HDF with a high convection volume.

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03810-9