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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.
We performed a Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted on PubMed, EMBASE, and Cochrane Central on July 01, 2023. We included studies with adult patients with ESK on regular KRT, evaluating HDF versus HD. Crossover trials, non-randomized studies and case reports were excluded. Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplants.
We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, while 2065 (49.8%) were on HD. Overall, HDF was associated with a lower risk of all-cause mortality (RR 0.81; 95% 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; 0.50-0.95; p = 0.02; I2 = 26%).
Compared to those undergoing HD, patients receiving HDF experienced a reduction in all-cause mortality, CV mortality, and infections-related mortality. These results provide compelling evidence supporting the use of HDF as a beneficial intervention in ESKD patients undergoing KRT.