Effects of different models of blood purification on clinical outcomes in patients with end-stage renal disease

Abstract

Objective To investigate the impact of different blood purification methods on clinical outcomes in patients with end-stage renal disease.Methods We searched Medline,Embase and the Cochrane library from the establishment of the databases to December 2013 to identify clinical trials on the impact of different blood purification methods on residual renal function,beta-2 microglobulin,albumin,and other indicators among maintenance hemodialysis patients.The bibliographies of included studies were searched.The quality of the selected trials was critically appraised and the data were extracted.Metaanalyses were conducted for the eligible trials.RevMan 5.1 and GRADEprofiler 3.6 software were used for statistical analysis.Results We identified 12 unique studies,including 2 583 patients.The meta-analysis found that:(1) there were no significant difference in Kt/V,urea,creatinine,β2-microglobulin,albumin,C-reactive protein (CRP),calcium,phosphate,parathyroid hormone (PTH),hemoglobin (Hb) and hematocrit (Hot) between hemodiafiltration (HDF) and hemodialysis (HD) groups; (2) compared with HDF,high-flux hemodialysis (HFHD) were associated with higher urea,and weighted mean difference (WMD,95％ confidence interval (CI) was 1.58 (0.57,2.59),but the Kt/V,creatinine,β2-microglobulin,albumin,CRP,calcium and phosphate levels did not significantly differ between the two treatment modalities; (3) similarly,no difference between HDF and low-flux hemodialysis (LFHD) was observed for creatinine and β2-microglobulin,but there was a significant increase in the plasma level of Alb,WMD (95％ CI) was 0.91 (0.60,1.23).Conclusions Maintained hemodialysis patients with HDF compared to HD for removal of the material had no significant difference.We also divided HD into HFHD and LFHD groups and compared with HDF,the results showed that there were differences in urea and albumin. Key words: High flux hemodialysis; Low-flux hemodialysis; Hemodiafiltration