Efficacy and incidence of complications of hemodialysis in the treatment of diabetic nephropathy: a systematic review and meta-analysis.

Abstract

Background: Diabetic kidney disease (DKD) progresses inexorably to kidney failure; whether initiating hemodialysis earlier than usual confers additional clinical benefit remains uncertain.

Objective: The aim of this study is to evaluate the effects of hemodialysis, compared with conventional medical care, on glycemic control, renal function, inflammatory markers, and treatment-related complications in adults with DKD.

Methods: We searched eight databases (Chinese Biomedical Database, Wanfang, CNKI, PubMed, EMBASE, ScienceDirect, Cochrane Library and VIP) and conference proceedings from January 2010 to 30 March 2025. Randomized controlled trials comparing hemodialysis plus standard therapy with standard therapy were eligible for inclusion in adult DKD patients. Two reviewers independently screened records extracted data and assessed risk of bias with the Cochrane Handbook 5.3 tool. Mean differences (MD) and 95% confidence intervals (CI) were pooled with random-effects models.

Results: Eight studies (645 participants) met the criteria. Compared with controls, hemodialysis significantly reduced parathyroid hormone (MD =  - 37.30, 95% CI - 43.16 to - 31.43; I² = 0%), tumour necrosis factor-α (MD =  - 15.29, 95% CI - 25.05 to - 5.53; I² = 89%), interleukin-4 (MD =  - 20.42, 95% CI - 25.89 to - 14.94; I² = 42%), and interleukin-8 (MD =  - 13.56, 95% CI - 20.85 to - 6.27; I² = 76%). Glycemic indices improved (fasting glucose MD =  - 0.80, 95% CI - 1.59 to - 0.02; HbA₁c MD =  - 0.63, 95% CI - 1.34 to 0.08). Serum creatinine (MD =  - 1.03, 95% CI - 1.69 to - 0.36) and blood urea nitrogen (MD =  - 0.94, 95% CI - 1.49 to - 0.39) also fell, despite high heterogeneity (I² ≥ 99%). Four studies reported complications; pooled analysis showed no significant difference in overall adverse events (risk ratio = 0.91, 95% CI 0.62 to 1.34).

Limitations: Evidence is based on small, single-center studies with unclear allocation concealment, substantial heterogeneity for several outcomes, and no assessment of long-term clinical endpoints.

Conclusion: In adults with DKD, adjunctive hemodialysis improves biochemical surrogates of renal function, inflammation, and glycemic control without increasing short-term complications. Robust multicentre randomised trials powered for patient-important outcomes are warranted.