Effect Of Extended Hemodialysis On Survival And Quality Of Life:a Meta-Analysis

Objective : Systemly evaluating extended hemodialysis on survival and quality of life to provide reference for treatment time。Methods:Prospectie case-control trial(PCT),cohort trial and randomized controlled trial(RCT)were searched from PumMed 、Web of Science、Ebsco 、 EBMR of Guang Xi Medical University Library about effect on different hemodialysis time mortality in patients with maintenance hemodialysis till March 10,2017。Then we used RevMam5.3 software to analysis data。Results:2 references of RCT,2 references of PCT and 9 references of cohort trials,a total of108523 patients were included in the study。11 studies compared hemodialysis duration >4h group with hemodialysis duration ≤4h group on mortality and 3 studies compared hemodialysis duration >4h group with hemodialysis duration ≤4h group on quality of life 。 The results of meta-analysis show that the hemodialysis duration >4h group is lower than the hemodialysis duration ≤4h group on mortality(RR 0.7,95%Cl [0.68,0.71],P<0.00001);In Subgroup analysis:(1)The hemodialysis time was 4 hours or shorter with high blood flow and high volume of the dialysate was the controlgroup,the hemodialysis time was more than 4 hours with low blood flow and low volume of the dialysate was the experimental group,experimental mortality rate is lower than the control group(RR 0.75,95%Cl [0.58,0.97],P=0.03);(2)when the hemodialysis duration was ≥8h,there was no diference beweet hemodialysis duration≥8h groups and hemodialysis duration≤4h group(RR 0.65,95%Cl [ 0.21,2.05],P=0.46);For hemodialysis duration≥ 8 h group on blood flow subgroup analysis: the mortality of low blood flowgroup was lower than the high blood flow rate and dialysate flow rate group(RR 0.25,95% Cl [0.09,0.65],P = 0.004);(3)When the hemodialysis duration was>4h and<8h,the mortality of hemodialysis duration > 4h and < 8h group is lower than hemodialysis duration ≤4h group(RR 0.64,95%Cl [0.63,0.66],P<0.00001);(4)the hemodialysis duration > 4h group is lower than the hemodialysis duration ≤4h group on phosphorus(MD-1.16,95%Cl[-1.39,-0.93],P<0.00001);(5)the hemodialysis duration > 4h group is higher than the hemodialysis duration ≤4h group on hemoglobin(MD 0.34,95%Cl[0.21,0.47],P<0.00001);(6)There was no difference between the hemodialysis duration>4h group and hemodialysis duration ≤4h group albumin and left ventricular mass index(MD 0.07,95%Cl[-0.01,0.15],P=0.09;MD-10.55,95%Cl[-26.23,5.13],P=0.19)(7)the hemodialysis duration >4h group is higher than the hemodialysis duration ≤4h group on physical composite score(MD 4.36,95%Cl[3.47,5.26],P<0.00001),but no difference between tow groups on mental composite score(MD 1.84,95%Cl[-3.34,7.03],P=0.49)。Conclusion:1.hemodialysis duration > 4 h with low blood flow and low dialysate flow rate can improve the survival rate of maintenance hemodialysis patients,the most appropriate treatment time was 4 to 8 h /session 。 2.The hemodialysis duration > 4 h modelcan increase phosphorus removal andimprove anemia and physical composite score,but the effect on albumin,mental composite score and left ventricular mass index was no difference compared with the hemodialysis duration ≤4 h model。...