Abstract
BackgroundEnd-stage renal disease (ESRD) is related to high morbidity, mortality, and impaired health-related quality of life. While hemodialysis (HD) is the current life-saving standard of treatment for patients with ESRD, their quality of life (QoL) remains far from desirable. Online HDF (OL-HDF), due to its convenience, could improve the QoL of patients with ESRD, however, this remains uncertain.ObjectiveWe aimed to assess the body of evidence of OL-HDF compared to HD regarding QoL in patients with ESRD.MethodsWe comprehensively searched in multiple data bases from their inception to February 2018. Reviewers working independently and in duplicate appraised the quality and included randomized controlled trials (RCTs) that evaluated, in patients with ESRD and HD or OL-HDF, QoL (Short Form Health Survey with 36 questions (SF-36) with physical component score (PCS) and mental component score (MCS) as well as scores about social activity, fatigue, and emotion). A meta-analysis of each outcome of interest was performed using a random-effects model.ResultsSix moderate quality RCTs met the inclusion criteria. Meta-analysis of 4 RCTs including a total of 1,209 patients showed that OL-HDF was associated with a lower yet non-significant score of PCS: MD (mean difference) -0.77 (95% CI -1.94 to 0.41, p = 0.20), and MCS: MD -1.25 (95% CI -3.10 to 0.59, p = 0.18); indicating a poorer QoL in patients on OL-HDF. Meta-analysis of 4 RCTs including a total of 845 patients showed OL-HDF was associated with a significant increase in the score of social activity compared to HD: SMD (standardized mean difference): 1.95 (95% CI 0.05 to 3.86, p = 0.04), indicating a better QoL in patients on OL-HDF; but regarding fatigue and emotion, there was no significant improvement when compared to HD by meta-analysis of 3 RCTs (133 patients).ConclusionsThe body of evidence suggests that OL-HDF does not improve QoL in patients with ESRD when compared to HD.
Highlights
For any healthcare system, the increasing number of patients with end-stage renal disease (ESRD) is a major concern and health priority
Meta-analysis of 4 randomized controlled trials (RCTs) including a total of 1,209 patients showed that Online HDF (OL-HDF) was associated with a lower yet non-significant score of physical component summary score (PCS): mean differences (MD) -0.77, and mental component summary score (MCS): MD
Metaanalysis of 4 RCTs including a total of 845 patients showed OL-HDF was associated with a significant increase in the score of social activity compared to HD: standardized mean difference (SMD): 1.95, indicating a better quality of life (QoL) in patients on OLHDF; but regarding fatigue and emotion, there was no significant improvement when compared to HD by meta-analysis of 3 RCTs (133 patients)
Summary
The increasing number of patients with end-stage renal disease (ESRD) is a major concern and health priority. Hemodialysis (HD) is a life-saving and the current standard of treatment for patients with ESRD. Survival rate and quality of life (QoL) of patients in this scenario is far from desirable. Previous studies suggest that convective modalities such as hemofiltration (HF) and hemodiafiltration (HDF) are associated with better removal of both small and middle molecules as well as greater hemodynamic stability, improved survival, and better QoL of patients with ESRD, compared with standard HD [2,3,4,5,6,7]. While hemodialysis (HD) is the current life-saving standard of treatment for patients with ESRD, their quality of life (QoL) remains far from desirable. Online HDF (OL-HDF), due to its convenience, could improve the QoL of patients with ESRD, this remains uncertain
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