Maria Gabriela Motta Guimarães , Fernanda Pinheiro Martin Tapioca , Naiara Rodrigues dos Santos , Fernanda Pitta do Carmo Tourinho Ferreira , Luiz Carlos Santana Passos , Paulo Novis Rocha
{"title":"终末期肾病中的血液滤过与血液透析：系统回顾和元分析","authors":"Maria Gabriela Motta Guimarães , Fernanda Pinheiro Martin Tapioca , Naiara Rodrigues dos Santos , Fernanda Pitta do Carmo Tourinho Ferreira , Luiz Carlos Santana Passos , Paulo Novis Rocha","doi":"10.1016/j.xkme.2024.100829","DOIUrl":null,"url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>The use of hemodiafiltration (HDF) as a kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD) has sparked a debate regarding its advantages over conventional hemodialysis (HD). The present study aims to shed light on this controversy by comparing mortality rates and cause-specific deaths between ESKD patients receiving HDF and those undergoing HD.</p></div><div><h3>Study Design</h3><p>Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023.</p></div><div><h3>Setting & Participants</h3><p>Adult patients with ESKD on regular KRT.</p></div><div><h3>Exposure</h3><p>Studies with participants undergoing HDF.</p></div><div><h3>Outcomes</h3><p>Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplant. We also evaluated the endpoints for deaths related to malignancy, myocardial infarction, stroke, arrhythmias, and sudden death.</p></div><div><h3>Analytical Approach</h3><p>We included RCTs evaluating HDF versus HD. Crossover trials and studies with overlapping populations were excluded. Two authors independently extracted the data following predefined search criteria and quality assessment. The risk of bias was assessed with Cochrane’s RoB2 tool.</p></div><div><h3>Results</h3><p>We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, whereas 2,065 (49.8%) were receiving HD. Overall, HDF was associated with a lower risk of all-cause mortality (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.73-0.91; <em>P</em> <!--><<!--> <!-->0.001; I<sup>2</sup> <!-->=<!--> <!-->7%) and a lower risk of CV-related deaths (RR, 0.75; 95% CI, 0.61-0.92; <em>P</em> <!-->=<!--> <!-->0.007; I<sup>2</sup> <!-->=<!--> <!-->0%). The incidence of infection-related deaths was also significantly different between therapies (RR, 0.69; 95% CI, 0.50-0.95; <em>P</em> <!-->=<!--> <!-->0.02; I<sup>2</sup> <!-->=<!--> <!-->26%).</p></div><div><h3>Limitations</h3><p>In individual studies, the HDF groups achieved varying levels of convection volume.</p></div><div><h3>Conclusions</h3><p>Compared with those undergoing HD, patients receiving HDF experienced a reduction in all-cause mortality, CV mortality, and infection-related mortality. These results provide compelling evidence supporting the use of HDF as a beneficial intervention in ESKD patients undergoing KRT.</p></div><div><h3>Registration</h3><p>Registered at PROSPERO: CRD42023438362.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100829"},"PeriodicalIF":3.2000,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000402/pdfft?md5=e3c3711e7e84ef736a4090316fd2ad24&pid=1-s2.0-S2590059524000402-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Hemodiafiltration versus Hemodialysis in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis\",\"authors\":\"Maria Gabriela Motta Guimarães , Fernanda Pinheiro Martin Tapioca , Naiara Rodrigues dos Santos , Fernanda Pitta do Carmo Tourinho Ferreira , Luiz Carlos Santana Passos , Paulo Novis Rocha\",\"doi\":\"10.1016/j.xkme.2024.100829\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Rationale & Objective</h3><p>The use of hemodiafiltration (HDF) as a kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD) has sparked a debate regarding its advantages over conventional hemodialysis (HD). The present study aims to shed light on this controversy by comparing mortality rates and cause-specific deaths between ESKD patients receiving HDF and those undergoing HD.</p></div><div><h3>Study Design</h3><p>Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023.</p></div><div><h3>Setting & Participants</h3><p>Adult patients with ESKD on regular KRT.</p></div><div><h3>Exposure</h3><p>Studies with participants undergoing HDF.</p></div><div><h3>Outcomes</h3><p>Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplant. We also evaluated the endpoints for deaths related to malignancy, myocardial infarction, stroke, arrhythmias, and sudden death.</p></div><div><h3>Analytical Approach</h3><p>We included RCTs evaluating HDF versus HD. Crossover trials and studies with overlapping populations were excluded. Two authors independently extracted the data following predefined search criteria and quality assessment. The risk of bias was assessed with Cochrane’s RoB2 tool.</p></div><div><h3>Results</h3><p>We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, whereas 2,065 (49.8%) were receiving HD. Overall, HDF was associated with a lower risk of all-cause mortality (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.73-0.91; <em>P</em> <!--><<!--> <!-->0.001; I<sup>2</sup> <!-->=<!--> <!-->7%) and a lower risk of CV-related deaths (RR, 0.75; 95% CI, 0.61-0.92; <em>P</em> <!-->=<!--> <!-->0.007; I<sup>2</sup> <!-->=<!--> <!-->0%). The incidence of infection-related deaths was also significantly different between therapies (RR, 0.69; 95% CI, 0.50-0.95; <em>P</em> <!-->=<!--> <!-->0.02; I<sup>2</sup> <!-->=<!--> <!-->26%).</p></div><div><h3>Limitations</h3><p>In individual studies, the HDF groups achieved varying levels of convection volume.</p></div><div><h3>Conclusions</h3><p>Compared with those undergoing HD, patients receiving HDF experienced a reduction in all-cause mortality, CV mortality, and infection-related mortality. 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Hemodiafiltration versus Hemodialysis in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis
Rationale & Objective
The use of hemodiafiltration (HDF) as a kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD) has sparked a debate regarding its advantages over conventional hemodialysis (HD). The present study aims to shed light on this controversy by comparing mortality rates and cause-specific deaths between ESKD patients receiving HDF and those undergoing HD.
Study Design
Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023.
Setting & Participants
Adult patients with ESKD on regular KRT.
Exposure
Studies with participants undergoing HDF.
Outcomes
Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplant. We also evaluated the endpoints for deaths related to malignancy, myocardial infarction, stroke, arrhythmias, and sudden death.
Analytical Approach
We included RCTs evaluating HDF versus HD. Crossover trials and studies with overlapping populations were excluded. Two authors independently extracted the data following predefined search criteria and quality assessment. The risk of bias was assessed with Cochrane’s RoB2 tool.
Results
We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, whereas 2,065 (49.8%) were receiving HD. Overall, HDF was associated with a lower risk of all-cause mortality (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.73-0.91; P < 0.001; I2 = 7%) and a lower risk of CV-related deaths (RR, 0.75; 95% CI, 0.61-0.92; P = 0.007; I2 = 0%). The incidence of infection-related deaths was also significantly different between therapies (RR, 0.69; 95% CI, 0.50-0.95; P = 0.02; I2 = 26%).
Limitations
In individual studies, the HDF groups achieved varying levels of convection volume.
Conclusions
Compared with those undergoing HD, patients receiving HDF experienced a reduction in all-cause mortality, CV mortality, and infection-related mortality. These results provide compelling evidence supporting the use of HDF as a beneficial intervention in ESKD patients undergoing KRT.
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