The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD: systematic review

Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD: systematic review
Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD: systematic review
Background: We performed a systematic review of randomized controlled trials (RCTs) comparing hemodialysis (HD), hemofiltration (HF), hemodiafiltration (HDF), and acetate-free biofiltration (AFB) in the treatment of patients with end-stage renal disease to assess their clinical effectiveness.
Methods: The Cochrane CENTRAL Registry, MEDLINE, EMBASE, CINAHL, the American College of Physicians Database, Database of Abstracts of Reviews of Effectiveness, and reference lists were searched for randomized trials of HF, HDF, and AFB compared with HD; HDF compared with AFB; and HF compared with HDF. Two reviewers extracted data for all-cause mortality; hypotension, headache, nausea, vomiting, and any other adverse symptoms; quality of life (QoL); hospitalization; dialysis adequacy; and end-of-treatment beta 2 -microglobulin levels. Analysis was by means of a random-effects model, and results are expressed as relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs).
Results: Eighteen eligible trials (588 patients) were identified. HDF was associated with significantly greater mortality risk than HD (4 trials, 326 patients; RR, 3.52; 95% CI, 1.37 to 9.47). Risk for mortality was not different among the other comparisons. Risks for hypotension episodes and dialysis-related symptoms were not significantly different with HD, HF, HDF, and AFB (18 trials, 583 patients). QoL, assessed by using an unvalidated scoring tool, appeared to be significantly improved in patients on HDF therapy than those on HD therapy (1 trial, 67 patients; WMD, 0.6; 95% CI, 0.3 to 0.9), but this was not evident when validated QoL assessment tools were used. Use of AFB compared with HDF was not associated with a significant difference in risk for hospitalization (1 trial, 11 patients; WMD, -0.45; 95% CI, -1.42 to 0.52). HDF in comparison to HD did not reduce the risk for carpal tunnel syndrome (1 trial, 67 patients; RR, 2.04; 95% CI, 0.59 to 7.00). Kt/V was significantly different with HDF compared with HD (3 trials, 124 patients; WMD, 0.14; 95% CI, 0.05 to 0.22). No other substantial data for these interventions and their impact on major patient-centered outcomes were available.
Conclusion: The trials assessed were not powered adequately and had suboptimal method quality. It is not possible on the basis of effectiveness to prefer one extracorporeal renal replacement therapy modality to the other for end-stage kidney disease because significant differences in clinically important outcomes have not been shown by available published RCTs.
etiology, adverse effects, hospitalization, quality of life, blood pressure, treatment outcome, adolescent, beta 2-microglobulin, review, renal dialysis, treatment, hemodiafiltration, hypotension, physicians, disease, syndrome, humans, amyloidosis, mortality, hemofiltration, medline, carpal tunnel syndrome, risk, patients, comparative study, child, adult, kidney failure, nausea, chronic, therapy, female, kidney, renal replacement therapy, hemodialysis solutions, methods, confidence intervals, blood, headache, preschool, solutions, randomized controlled trials, non-u.s.gov't, aged, vomiting, epidemiology, statistics & numerical data, registries, analysis, research support, acetates, male, middle aged
0272-6386
437-447
Rabindranath, K.S.
f78daf66-8dbb-4631-a4ca-87b1f804fe04
Strippoli, G.F.
1c3095c2-49c6-4046-8f7a-b1cf53b1c26f
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Wallace, S.A.
69500a13-b232-4e84-80a4-db76e6a49c3f
Macleod, A.M.
40ca3b20-df13-4c01-ad89-0ade9b4ae717
Daly, C.
035ecaae-e5a8-4561-8d8f-20483c085cfe
Rabindranath, K.S.
f78daf66-8dbb-4631-a4ca-87b1f804fe04
Strippoli, G.F.
1c3095c2-49c6-4046-8f7a-b1cf53b1c26f
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Wallace, S.A.
69500a13-b232-4e84-80a4-db76e6a49c3f
Macleod, A.M.
40ca3b20-df13-4c01-ad89-0ade9b4ae717
Daly, C.
035ecaae-e5a8-4561-8d8f-20483c085cfe

Rabindranath, K.S., Strippoli, G.F., Roderick, P., Wallace, S.A., Macleod, A.M. and Daly, C. (2005) Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD: systematic review. American Journal of Kidney Diseases, 45 (3), 437-447. (doi:10.1053/j.ajkd.2004.11.008).

Record type: Article

Abstract

Background: We performed a systematic review of randomized controlled trials (RCTs) comparing hemodialysis (HD), hemofiltration (HF), hemodiafiltration (HDF), and acetate-free biofiltration (AFB) in the treatment of patients with end-stage renal disease to assess their clinical effectiveness.
Methods: The Cochrane CENTRAL Registry, MEDLINE, EMBASE, CINAHL, the American College of Physicians Database, Database of Abstracts of Reviews of Effectiveness, and reference lists were searched for randomized trials of HF, HDF, and AFB compared with HD; HDF compared with AFB; and HF compared with HDF. Two reviewers extracted data for all-cause mortality; hypotension, headache, nausea, vomiting, and any other adverse symptoms; quality of life (QoL); hospitalization; dialysis adequacy; and end-of-treatment beta 2 -microglobulin levels. Analysis was by means of a random-effects model, and results are expressed as relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs).
Results: Eighteen eligible trials (588 patients) were identified. HDF was associated with significantly greater mortality risk than HD (4 trials, 326 patients; RR, 3.52; 95% CI, 1.37 to 9.47). Risk for mortality was not different among the other comparisons. Risks for hypotension episodes and dialysis-related symptoms were not significantly different with HD, HF, HDF, and AFB (18 trials, 583 patients). QoL, assessed by using an unvalidated scoring tool, appeared to be significantly improved in patients on HDF therapy than those on HD therapy (1 trial, 67 patients; WMD, 0.6; 95% CI, 0.3 to 0.9), but this was not evident when validated QoL assessment tools were used. Use of AFB compared with HDF was not associated with a significant difference in risk for hospitalization (1 trial, 11 patients; WMD, -0.45; 95% CI, -1.42 to 0.52). HDF in comparison to HD did not reduce the risk for carpal tunnel syndrome (1 trial, 67 patients; RR, 2.04; 95% CI, 0.59 to 7.00). Kt/V was significantly different with HDF compared with HD (3 trials, 124 patients; WMD, 0.14; 95% CI, 0.05 to 0.22). No other substantial data for these interventions and their impact on major patient-centered outcomes were available.
Conclusion: The trials assessed were not powered adequately and had suboptimal method quality. It is not possible on the basis of effectiveness to prefer one extracorporeal renal replacement therapy modality to the other for end-stage kidney disease because significant differences in clinically important outcomes have not been shown by available published RCTs.

This record has no associated files available for download.

More information

Published date: 2005
Keywords: etiology, adverse effects, hospitalization, quality of life, blood pressure, treatment outcome, adolescent, beta 2-microglobulin, review, renal dialysis, treatment, hemodiafiltration, hypotension, physicians, disease, syndrome, humans, amyloidosis, mortality, hemofiltration, medline, carpal tunnel syndrome, risk, patients, comparative study, child, adult, kidney failure, nausea, chronic, therapy, female, kidney, renal replacement therapy, hemodialysis solutions, methods, confidence intervals, blood, headache, preschool, solutions, randomized controlled trials, non-u.s.gov't, aged, vomiting, epidemiology, statistics & numerical data, registries, analysis, research support, acetates, male, middle aged

Identifiers

Local EPrints ID: 62076
URI: http://eprints.soton.ac.uk/id/eprint/62076
ISSN: 0272-6386
PURE UUID: 871e40a5-aab2-44cb-9cc6-d815270cfe77
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 03 Sep 2008
Last modified: 09 Jan 2022 02:47

Export record

Altmetrics

Contributors

Author: K.S. Rabindranath
Author: G.F. Strippoli
Author: P. Roderick ORCID iD
Author: S.A. Wallace
Author: A.M. Macleod
Author: C. Daly

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×