Hemodiafiltration and Mortality in ESRD Patients

Researchers have discovered that a significant reduction in mortality occurs in patients with end-stage renal disease (ESRD) when hemodiafiltration (HDF) is used instead of conventional hemodialysis. A recent study was conducted by Yifan and colleagues published in BMC Nephrology.

In ESRD, a patient always requires dialysis for the removal of the waste products and excess fluids from the blood. Standard treatment is conventional hemodialysis, but in the last few years, HDF has been investigated concerning its apparent advantages regarding mortality as it is a modified form of dialysis that increases toxin removal by combining diffusion and convection.

The researchers systematically searched PubMed, Embase, and the Cochrane Library for RCTs comparing HDF with conventional HD up until January 14, 2024, to collect credible evidence. A total of 10 randomized controlled trials involving 4654 patients were included. The analysis was performed using Review Manager 5.3 software, enabling the assessment of relevant data and the quality of the evidence. The study results focused on four main outcomes: all-cause mortality, cardiovascular mortality, sudden death, and infection-related mortality.

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