Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease

Kannaiyan S Rabindranath, Giovanni FM Strippoli, Conal Daly, Paul J Roderick, Sheila A Wallace, Alison M MacLeod

Research output: Contribution to journalLiterature review

45 Citations (Scopus)

Abstract

Background Renal replacement therapy (RRT) for end-stage kidney disease (ESKD) can be achieved by several interventions including haemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation. HD, haemofiltration (HF), haemodiafiltration (HDF) and acetate-free biofiltration (AFB) are extracorporeal RRT methods. It has been suggested that HF and HDF may reduce the frequency and severity of intradialytic and post-dialytic adverse symptoms and may be more effective than HD in the removal of high molecular weight molecules.

Objectives To compare convective modes of extracorporeal RRT ( HF, HDF or AFB) with HD and to establish if any of these techniques is superior to each other in patients with ESKD.

Search strategy We searched MEDLINE (1966-2006), EMBASE (1980-2006), Cochrane Central Register of Controlled Trials ( CENTRAL, in The Cochrane Library issue 2, 2006) and CINAHL (1872-2006). Authors of included studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened.

Selection criteria RCTs comparing HF, HDF, AFB and HD for ESKD were included. Trials enrolling any patient undergoing RRT for ESKD were included.

Data collection and analysis Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weighted mean difference ( MD) for continuous data with 95% confidence intervals (CI). Heterogeneity was measured using the Chi-square (chi(2)) and I-2 statistic.

Main results Twenty studies ( 657 patients) were included. Seventeen studies compared HF, HDF or AFB with HD, two compared HDF with AFB and one compared HF with HDF. The studies were generally small with suboptimal quality. Convective modalities ( HF, HDF, AFB) did not differ significantly from HD for mortality (RR 1.68, 95% CI 0.23 to 12.13; chi(2)=2.58, P = 0.11, I-2 = 61.2%), number of hospital admissions/year (MD 0.20, 95% CI -0.07 to 0.47) and dialysis adequacy (Kt/V: MD 0.09, 95% CI 0.02 to 0.17; chi(2) = 3.73, P = 0.29, I2 = 19.6%). No study assessed number of dialysis treatments associated with "any adverse symptoms", sessions that were stopped early, change of dialysis modality or dialysis-related amyloidosis.

Authors' conclusions We were unable to demonstrate whether convective modalities (either HF, HDF or AFB) have significant advantages over HD with regard to clinically important outcomes of mortality, dialysis-related hypotension and hospitalisation. More adequately-powered good quality RCTs assessing clinically important outcomes (mortality, hospitalisation, quality of life) are needed.

Original languageEnglish
Article numberCD006258
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 18 Oct 2006

Keywords

  • acetate-free biofiltration
  • online predilution hemofiltration
  • renal replacement therapy
  • high-flux hemodialysis
  • prospective cross-over
  • bicarbonate dialysis
  • cardiovascular-response
  • Sardinian multicenter
  • substitution fluid
  • remarkable removal

Cite this

Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease. / Rabindranath, Kannaiyan S; Strippoli, Giovanni FM; Daly, Conal; Roderick, Paul J; Wallace, Sheila A; MacLeod, Alison M.

In: Cochrane Database of Systematic Reviews, No. 4, CD006258, 18.10.2006.

Research output: Contribution to journalLiterature review

Rabindranath, Kannaiyan S ; Strippoli, Giovanni FM ; Daly, Conal ; Roderick, Paul J ; Wallace, Sheila A ; MacLeod, Alison M. / Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease. In: Cochrane Database of Systematic Reviews. 2006 ; No. 4.
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title = "Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease",
abstract = "Background Renal replacement therapy (RRT) for end-stage kidney disease (ESKD) can be achieved by several interventions including haemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation. HD, haemofiltration (HF), haemodiafiltration (HDF) and acetate-free biofiltration (AFB) are extracorporeal RRT methods. It has been suggested that HF and HDF may reduce the frequency and severity of intradialytic and post-dialytic adverse symptoms and may be more effective than HD in the removal of high molecular weight molecules.Objectives To compare convective modes of extracorporeal RRT ( HF, HDF or AFB) with HD and to establish if any of these techniques is superior to each other in patients with ESKD.Search strategy We searched MEDLINE (1966-2006), EMBASE (1980-2006), Cochrane Central Register of Controlled Trials ( CENTRAL, in The Cochrane Library issue 2, 2006) and CINAHL (1872-2006). Authors of included studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened.Selection criteria RCTs comparing HF, HDF, AFB and HD for ESKD were included. Trials enrolling any patient undergoing RRT for ESKD were included.Data collection and analysis Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weighted mean difference ( MD) for continuous data with 95{\%} confidence intervals (CI). Heterogeneity was measured using the Chi-square (chi(2)) and I-2 statistic.Main results Twenty studies ( 657 patients) were included. Seventeen studies compared HF, HDF or AFB with HD, two compared HDF with AFB and one compared HF with HDF. The studies were generally small with suboptimal quality. Convective modalities ( HF, HDF, AFB) did not differ significantly from HD for mortality (RR 1.68, 95{\%} CI 0.23 to 12.13; chi(2)=2.58, P = 0.11, I-2 = 61.2{\%}), number of hospital admissions/year (MD 0.20, 95{\%} CI -0.07 to 0.47) and dialysis adequacy (Kt/V: MD 0.09, 95{\%} CI 0.02 to 0.17; chi(2) = 3.73, P = 0.29, I2 = 19.6{\%}). No study assessed number of dialysis treatments associated with {"}any adverse symptoms{"}, sessions that were stopped early, change of dialysis modality or dialysis-related amyloidosis.Authors' conclusions We were unable to demonstrate whether convective modalities (either HF, HDF or AFB) have significant advantages over HD with regard to clinically important outcomes of mortality, dialysis-related hypotension and hospitalisation. More adequately-powered good quality RCTs assessing clinically important outcomes (mortality, hospitalisation, quality of life) are needed.",
keywords = "acetate-free biofiltration, online predilution hemofiltration, renal replacement therapy, high-flux hemodialysis, prospective cross-over, bicarbonate dialysis, cardiovascular-response, Sardinian multicenter, substitution fluid, remarkable removal",
author = "Rabindranath, {Kannaiyan S} and Strippoli, {Giovanni FM} and Conal Daly and Roderick, {Paul J} and Wallace, {Sheila A} and MacLeod, {Alison M}",
year = "2006",
month = "10",
day = "18",
doi = "10.1002/14651858.CD006258",
language = "English",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
publisher = "Wiley",
number = "4",

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TY - JOUR

T1 - Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease

AU - Rabindranath, Kannaiyan S

AU - Strippoli, Giovanni FM

AU - Daly, Conal

AU - Roderick, Paul J

AU - Wallace, Sheila A

AU - MacLeod, Alison M

PY - 2006/10/18

Y1 - 2006/10/18

N2 - Background Renal replacement therapy (RRT) for end-stage kidney disease (ESKD) can be achieved by several interventions including haemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation. HD, haemofiltration (HF), haemodiafiltration (HDF) and acetate-free biofiltration (AFB) are extracorporeal RRT methods. It has been suggested that HF and HDF may reduce the frequency and severity of intradialytic and post-dialytic adverse symptoms and may be more effective than HD in the removal of high molecular weight molecules.Objectives To compare convective modes of extracorporeal RRT ( HF, HDF or AFB) with HD and to establish if any of these techniques is superior to each other in patients with ESKD.Search strategy We searched MEDLINE (1966-2006), EMBASE (1980-2006), Cochrane Central Register of Controlled Trials ( CENTRAL, in The Cochrane Library issue 2, 2006) and CINAHL (1872-2006). Authors of included studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened.Selection criteria RCTs comparing HF, HDF, AFB and HD for ESKD were included. Trials enrolling any patient undergoing RRT for ESKD were included.Data collection and analysis Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weighted mean difference ( MD) for continuous data with 95% confidence intervals (CI). Heterogeneity was measured using the Chi-square (chi(2)) and I-2 statistic.Main results Twenty studies ( 657 patients) were included. Seventeen studies compared HF, HDF or AFB with HD, two compared HDF with AFB and one compared HF with HDF. The studies were generally small with suboptimal quality. Convective modalities ( HF, HDF, AFB) did not differ significantly from HD for mortality (RR 1.68, 95% CI 0.23 to 12.13; chi(2)=2.58, P = 0.11, I-2 = 61.2%), number of hospital admissions/year (MD 0.20, 95% CI -0.07 to 0.47) and dialysis adequacy (Kt/V: MD 0.09, 95% CI 0.02 to 0.17; chi(2) = 3.73, P = 0.29, I2 = 19.6%). No study assessed number of dialysis treatments associated with "any adverse symptoms", sessions that were stopped early, change of dialysis modality or dialysis-related amyloidosis.Authors' conclusions We were unable to demonstrate whether convective modalities (either HF, HDF or AFB) have significant advantages over HD with regard to clinically important outcomes of mortality, dialysis-related hypotension and hospitalisation. More adequately-powered good quality RCTs assessing clinically important outcomes (mortality, hospitalisation, quality of life) are needed.

AB - Background Renal replacement therapy (RRT) for end-stage kidney disease (ESKD) can be achieved by several interventions including haemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation. HD, haemofiltration (HF), haemodiafiltration (HDF) and acetate-free biofiltration (AFB) are extracorporeal RRT methods. It has been suggested that HF and HDF may reduce the frequency and severity of intradialytic and post-dialytic adverse symptoms and may be more effective than HD in the removal of high molecular weight molecules.Objectives To compare convective modes of extracorporeal RRT ( HF, HDF or AFB) with HD and to establish if any of these techniques is superior to each other in patients with ESKD.Search strategy We searched MEDLINE (1966-2006), EMBASE (1980-2006), Cochrane Central Register of Controlled Trials ( CENTRAL, in The Cochrane Library issue 2, 2006) and CINAHL (1872-2006). Authors of included studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened.Selection criteria RCTs comparing HF, HDF, AFB and HD for ESKD were included. Trials enrolling any patient undergoing RRT for ESKD were included.Data collection and analysis Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weighted mean difference ( MD) for continuous data with 95% confidence intervals (CI). Heterogeneity was measured using the Chi-square (chi(2)) and I-2 statistic.Main results Twenty studies ( 657 patients) were included. Seventeen studies compared HF, HDF or AFB with HD, two compared HDF with AFB and one compared HF with HDF. The studies were generally small with suboptimal quality. Convective modalities ( HF, HDF, AFB) did not differ significantly from HD for mortality (RR 1.68, 95% CI 0.23 to 12.13; chi(2)=2.58, P = 0.11, I-2 = 61.2%), number of hospital admissions/year (MD 0.20, 95% CI -0.07 to 0.47) and dialysis adequacy (Kt/V: MD 0.09, 95% CI 0.02 to 0.17; chi(2) = 3.73, P = 0.29, I2 = 19.6%). No study assessed number of dialysis treatments associated with "any adverse symptoms", sessions that were stopped early, change of dialysis modality or dialysis-related amyloidosis.Authors' conclusions We were unable to demonstrate whether convective modalities (either HF, HDF or AFB) have significant advantages over HD with regard to clinically important outcomes of mortality, dialysis-related hypotension and hospitalisation. More adequately-powered good quality RCTs assessing clinically important outcomes (mortality, hospitalisation, quality of life) are needed.

KW - acetate-free biofiltration

KW - online predilution hemofiltration

KW - renal replacement therapy

KW - high-flux hemodialysis

KW - prospective cross-over

KW - bicarbonate dialysis

KW - cardiovascular-response

KW - Sardinian multicenter

KW - substitution fluid

KW - remarkable removal

U2 - 10.1002/14651858.CD006258

DO - 10.1002/14651858.CD006258

M3 - Literature review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 4

M1 - CD006258

ER -