■在终末期肾病(ESKD)患者中使用血液透析滤过(HDF)作为肾脏替代疗法(KRT)引发了关于其优于常规血液透析(HD)的争论。本研究旨在通过比较接受HDF的ESKD患者和接受HD的患者之间的死亡率和特定于原因的死亡来阐明这一争议。
■随机对照试验(RCT)的系统评价和荟萃分析。搜索是使用PubMed进行的,EMBASE,和CochraneCentral在2023年7月1日。
■接受常规KRT治疗的ESKD成年患者。
■对接受HDF的参与者进行研究。
■主要结果是全因死亡率,心血管(CV)死亡率,与感染有关的死亡,和肾脏移植。我们还评估了与恶性肿瘤相关的死亡终点,心肌梗塞,中风,心律失常,突然死亡。
■我们包括评估HDF与HD的RCT。交叉试验和具有重叠群体的研究被排除。两位作者根据预定义的搜索标准和质量评估独立地提取数据。使用Cochrane的RoB2工具评估偏倚风险。
■我们纳入了4,143名患者的5个随机对照试验,其中2078人(50.1%)接受了HDF,而2,065(49.8%)正在接受HD。总的来说,HDF与全因死亡率风险较低相关(风险比[RR],0.81;95%置信区间[CI],0.73-0.91;P<0.001;I2=7%)和较低的CV相关死亡风险(RR,0.75;95%CI,0.61-0.92;P=0.007;I2=0%)。感染相关死亡的发生率在治疗之间也有显著差异(RR,0.69;95%CI,0.50-0.95;P=0.02;I2=26%)。
■在个别研究中,HDF组实现了不同水平的对流量。
■与接受HD的人相比,接受HDF的患者全因死亡率降低,CV死亡率,和感染相关的死亡率。这些结果提供了令人信服的证据,支持将HDF用作接受KRT的ESKD患者的有益干预措施。
■注册于PROSPERO:CRD42023438362。
UNASSIGNED: 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.
UNASSIGNED: Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023.
UNASSIGNED: Adult patients with ESKD on regular KRT.
UNASSIGNED: Studies with participants undergoing HDF.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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%).
UNASSIGNED: In individual studies, the HDF groups achieved varying levels of convection volume.
UNASSIGNED: 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.
UNASSIGNED: Registered at PROSPERO: CRD42023438362.