Systematic review to compare the outcomes associated with the modalities of expanded hemodialysis (HDx) versus high‐flux hemodialysis and/or hemodiafiltration (HDF) in patients with end‐stage kidney disease (ESKD)

Abstract

Background: This systematic review was performed to identify recent published comparative evidence on the efficacy, effectiveness, and safety of expanded hemodialysis (HDx) versus high-flux HD and/or hemodiafiltration (HDF) for long-term outcomes in end-stage kidney disease.Methods: Systematic literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Medline, Medline ® Epub Ahead of Print, EconLit, Embase, and EBM reviews were searched to identify relevant publications from 2013 onwards. Eligibility criteria included clinical studies reporting mortality, hospitalizations, cardiovascular outcomes, economic evaluations, cost studies, and quality of life (QoL) studies.Results: A total of 79 relevant studies were identified with 29 prioritized for detailed analysis; four compared HDx to HD, one compared HDF and HDx, and 24 compared HDF with HD. A total of 13 randomized controlled trial (RCT)-based studies were identified; 11 compared HDF with HD, one compared HDx with HD, and one compared HDF with HDx. Follow-up duration ranged from 16 weeks to 7 years for HDF studies and from 12 weeks to 1 year for HDx studies. HDF showed significant improvements in mortality, cardiovascular outcomes, hospitalizations, and QoL versus high-flux HD. One study reported mortality outcomes for HDx and found no difference versus HDF. QoL benefits with HDx were reported in a small number of studies. Conclusion:The efficacy and safety of HDF is supported by a robust evidence base that includes several RCTs. While HDx may offer benefits over high-flux HD, longterm studies are required to compare HDx with online high volume HDF.

Removal of Middle Molecules and Dialytic Albumin Loss: A Cross-over Study of Medium Cutoff and High-Flux Membranes with Hemodialysis and Hemodiafiltration

“…In brief, findings of our study are in line with a recent systematic review exploring the effects of MCO dialysis with HFX-HD and HDF. 33…”

“…Our study protocol did not aim to address this question, and long-term outcome studies—ideally sufficiently powered randomized controlled trials—are warranted to quantitate the risk/benefit ratio of MCO versus HFX-HD and HFX-HDF, respectively. Of note, a meta-analysis 33 found a slight reduction in serum albumin over the short term that seemed to normalize over the long term, suggesting compensatory mechanisms such as increased albumin synthesis. Absent adequate clinical trials, clinical judgment, and understanding of pathophysiology will inform treatment choices made by the dialysis practitioner caring for HD patients.…”