Comparative efficacy of expanded hemodialysis and online hemodiafiltration: a systematic review and meta-analysis.

IF 1.8 4区医学 Q3 UROLOGY & NEPHROLOGY

International Urology and Nephrology Pub Date : 2025-05-10 DOI:10.1007/s11255-025-04559-2

Ozgur Aktas, Ruslan Akhmedullin, Anara Abbay, Arif E Narin, Muharrem S Yanilmaz, Candan Genc, Abduzhappar Gaipov, Adrian Covic, Mehmet Kanbay

{"title":"Comparative efficacy of expanded hemodialysis and online hemodiafiltration: a systematic review and meta-analysis.","authors":"Ozgur Aktas, Ruslan Akhmedullin, Anara Abbay, Arif E Narin, Muharrem S Yanilmaz, Candan Genc, Abduzhappar Gaipov, Adrian Covic, Mehmet Kanbay","doi":"10.1007/s11255-025-04559-2","DOIUrl":null,"url":null,"abstract":"Background and aim: The comparison between online hemodiafiltration (online HDF) and expanded hemodialysis (HDx) remains undetermined. This systematic review and meta-analysis were conducted to provide comparative evidence on the molecule clearance, efficacy, and all-cause mortality of HDx versus online HDF in patients with end-stage kidney disease (ESKD).Materials and methods: A comprehensive search was conducted up to September 10, 2024, using various electronic databases PubMed, Cochrane Library, Scopus, Web of Science, and Ovid MEDLINE with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk ratios (RR) for binary outcomes and standardized mean differences (Hedge's g) were used for continuous outcomes.Results: The meta-analysis included eight studies, consisting of 614 patients in total. No statistical difference in all-cause mortality was found between HDx and online HDF (RR 0.97; 95% Cl 0.62-1.53, p = 0.91, I2 = 0%). Online HDF revealed a decrease in β2-microglobulin clearance (Hedges's g = - 0.61, 95% CI - 1.04 to - 0.18, p = 0.01), with no differences in creatinine, phosphate, and urea clearance. Prolactin clearance favored online HDF (Hedge's g = - 1.49, 95% Cl - 3.36 to 0.37, p = 0.12) but the pooled estimate remained insignificant, with high heterogeneity (I2 = 90.87%).Conclusion: Overall, both modalities are found to be effective, but online HDF revealed superior efficacy with potential advantages in middle-molecule clearance. Further standardized, randomized, and high-quality trials are required not only to confirm these findings but also to address the substantial heterogeneity found in the clearance of prolactin, myoglobulin, and albumin loss.Registration: PROSPERO registration number: CRD42024622632.","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Urology and Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11255-025-04559-2","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and aim: The comparison between online hemodiafiltration (online HDF) and expanded hemodialysis (HDx) remains undetermined. This systematic review and meta-analysis were conducted to provide comparative evidence on the molecule clearance, efficacy, and all-cause mortality of HDx versus online HDF in patients with end-stage kidney disease (ESKD).

Materials and methods: A comprehensive search was conducted up to September 10, 2024, using various electronic databases PubMed, Cochrane Library, Scopus, Web of Science, and Ovid MEDLINE with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk ratios (RR) for binary outcomes and standardized mean differences (Hedge's g) were used for continuous outcomes.

Results: The meta-analysis included eight studies, consisting of 614 patients in total. No statistical difference in all-cause mortality was found between HDx and online HDF (RR 0.97; 95% Cl 0.62-1.53, p = 0.91, I² = 0%). Online HDF revealed a decrease in β2-microglobulin clearance (Hedges's g = - 0.61, 95% CI - 1.04 to - 0.18, p = 0.01), with no differences in creatinine, phosphate, and urea clearance. Prolactin clearance favored online HDF (Hedge's g = - 1.49, 95% Cl - 3.36 to 0.37, p = 0.12) but the pooled estimate remained insignificant, with high heterogeneity (I² = 90.87%).

Conclusion: Overall, both modalities are found to be effective, but online HDF revealed superior efficacy with potential advantages in middle-molecule clearance. Further standardized, randomized, and high-quality trials are required not only to confirm these findings but also to address the substantial heterogeneity found in the clearance of prolactin, myoglobulin, and albumin loss.

Registration: PROSPERO registration number: CRD42024622632.

查看原文本刊更多论文

扩大血液透析和在线血液滤过的比较疗效：一项系统回顾和荟萃分析。

背景与目的：在线血液滤过（online HDF）和扩展血液透析（HDx）的比较尚不确定。本系统综述和荟萃分析旨在为终末期肾病（ESKD）患者中HDx与在线HDF的分子清除率、疗效和全因死亡率提供比较证据。材料和方法：采用PubMed、Cochrane Library、Scopus、Web of Science和Ovid MEDLINE等多种电子数据库，根据系统评价和meta分析指南的首选报告项目进行了全面的检索，截止到2024年9月10日。二元结果使用风险比（RR），连续结果使用标准化平均差异（Hedge’s g）。结果：meta分析纳入8项研究，共纳入614例患者。HDx和在线HDF的全因死亡率无统计学差异(RR 0.97；95% Cl = 0.62-1.53, p = 0.91, I2 = 0%)。在线HDF显示β2-微球蛋白清除率降低（Hedges的g = - 0.61, 95% CI - 1.04至- 0.18,p = 0.01），而肌酐、磷酸盐和尿素清除率无差异。催乳素清除率有利于在线HDF (Hedge’s g = - 1.49, 95% Cl = - 3.36至0.37,p = 0.12)，但汇总估计仍然不显著，异质性高（I2 = 90.87%）。结论：总的来说，两种方式都是有效的，但在线HDF显示出更优越的疗效，在中间分子清除方面具有潜在优势。进一步的标准化、随机化和高质量的试验不仅需要证实这些发现，而且需要解决在催乳素、肌红蛋白和白蛋白损失清除方面发现的实质性异质性。注册：普洛斯彼罗注册号：CRD42024622632。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Urology and Nephrology 医学-泌尿学与肾脏学

CiteScore

3.40

自引率

5.00%

发文量

329

审稿时长

1.7 months

期刊介绍： International Urology and Nephrology publishes original papers on a broad range of topics in urology, nephrology and andrology. The journal integrates papers originating from clinical practice.