The Impact Of Hemodiafiltration Versus High Flux Hemodialysis On The Long-Term Prognosis Of Maintenance Hemodialysis Patients:A Meta-Analysis

Background and Objective:There are almost 700 million patients with chronic kidney disease around the world nowadays,and a considerable number of them will progress to end-stage kidney disease(ESRD),which requires kidney replacement therapy.At present,the most important kidney replacement treatment method of ESRD is still hemodialysis.In recent years,high flux hemodialysis(HFHD)and hemodiafiltration(HDF)are developing rapidly,but the best mode of hemodialysis is still controversial.The purpose of this study is to further clarify the impact of HDF on the prognosis of maintenance hemodialysis(MHD)patients,and to provide evidence-based medical evidence for clinical practice.Methods:By comprehensively searching the relative databases such as pubmed、medline、embase、cochrane library、web of science、CNKI、Wanfang、VIP and other databases,we collected all the literature comparing the impact of HDF and HFHD on the long-term prognosis of MHD patients in the past 20 years.Then we screened the literature based on inclusion and exclusion criteria,and evaluated the quality of included literatures.Conclusively,we extracted the original data and used Review Manager 5.3 software for statistical analysis.Results:We included 15 studies with 19592 hemodialysis patients in this Meta-analysis.1.All-cause mortality:The all-cause mortality of HDF group was lower than that of HFHD group[OR=0.67,95 % CI(0.55-0.82),P < 0.0001],and the all-cause mortality of high convection volume HDF subgroup was lower than that of HFHD group,too [OR=0.54,95%CI(0.41-0.71),P<0.00001],while the all-cause mortality of low convection volume HDF subgroup was equal to that of HFHD group[OR=1.01,95%CI(0.75-1.37),P=0.94].2.hazard ratio(HR)of all-cause mortality:The all-cause mortality risk of HDF group was lower than that of HFHD group [HR=0.66,95%CI(0.51-0.85),P=0.002],and the all-cause mortality risk of high convection volume HDF subgroup was lower than that of HFHD group,too[HR=0.56,95 % CI(0.41-0.77),P=0.0004],while the all-cause mortality risk of low convection volume HDF subgroup was equal to that of HFHD group [HR=0.99,95%CI(0.73-1.34),P=0.92].3.Cardiovascular mortality:The cardiovascular mortality of HDF group was lower than that of HFHD group [OR=0.67,95%CI(0.55-0.82),P=0.0001].4.HR of cardiovascular mortality:The cardiovascular mortality risk of high convection volume HDF subgroup was lower than that of HFHD group [HR= 0.60,95%CI(0.43-0.84),P=0.003].5.Infection-related mortality:The infection-related mortality of HDF group was lower than that of HFHD group without statistical significance[OR=0.54,95%CI(0.28-1.07),P=0.08].6.The rate of all-cause hospital admissions:The rate of all-cause hospital admissions was significantly different between two groups[RR=0.83,95%CI(0.74-0.93),P=0.0009].Conclusions:This study suggests that high convection volume HDF can reduce all-cause and cardiovascular mortality risk in MHD patients,and reduce the rate of hospitalizations without increasing infection-related mortality,in a word,high convection volume HDF can improve the long-term prognosis of MHD patients.While low convection volume HDF can’t lower all-cause mortality.