Hemodiafiltration may reduce mortality in maintenance hemodialysis patients compared to conventional hemodialysis: Study

Key Findings

The meta-analysis led to several key findings regarding the impact of HDF compared to conventional HD

• All-cause mortality: The all-cause mortality was lower with HDF than with HD by 16%, (RR 0.84, 95% CI 0.72–0.99, P = 0.04).

• Cardiovascular mortality: HDF decreased cardiovascular mortality by 26%, (RR 0.74, 95% CI 0.61–0.90, P = 0.002).

• Sudden death: The risk of sudden death was not significantly different between the groups (RR 0.92, 95% CI 0.64–1.34, P = 0.68).

• Death from infection: While the point estimate indicated a reduction in infection-related mortality with HDF, the change was not significant (RR 0.70, 95% CI 0.47–1.03, P = 0.07).

• HDF had significant superiority to high-flux HD for all-cause mortality (RR 0.81, 95% CI 0.69–0.96, P = 0.01), but not over low-flux HD (RR 0.93, 95% CI 0.77–1.12, P = 0.44).

• Convective volume: HDF with a convective volume of 22 L or more was superior to the control in lowering both all-cause mortality (RR 0.76, 95% CI 0.65–0.88, P = 0.0002) and cardiovascular mortality (RR 0.73, 95% CI 0.54–0.94, P = 0.01).

The meta-analysis supports the fact that HDF significantly decreases mortality in ESRD patients compared to the conventional method of hemodialysis, with higher volumes of convection. Such preliminary evidence may eventually lead to increased adoption of HDF as a more regular procedure in the treatment of ESRD patients.

Reference:

Zhu, Y., Li, J., Lu, H., Shi, Z., & Wang, X. (2024). Effect of hemodiafiltration and hemodialysis on mortality of patients with end-stage kidney disease: a meta-analysis. BMC Nephrology, 25(1). https://doi.org/10.1186/s12882-024-03810-9