Effects of high-flux hemodialysis and hemodiafiltration on the mortality of patients with end-stage kidney disease: a meta-analysis

Figures & data

Figure 1. Flowchart of literature screening.

Table 1. General characteristics of the included literature.

Study	Location	Hemodialysis mode	Sample size	Study design	Follow-up (year)	Age	Female (%)	NOS score
Canaud et al. [17]	Europe	HFHD	546	Prospective cohort study	3	58.5	41.9	7
		OLHDF	253			62.5	39.5
Schiffl [19]	Germany	HFHD	38	RCT	2	59 ± 10	47.4	–
		OLHDF	38			63 ± 9	42.1
Vilar et al. [16]	UK	HFHD	626	Retrospective cohort study	5	64.2 ± 13.9	37.4	8
		OLHDF	232			53.1 ± 15.7	16.8
Locatelli et al. [24]	Italy	HFHD	40	RCT	2.2	54.6–74.3	45	–
		HDF	70			58.1–70.8	38.6
Grooteman et al. [11]	Netherlands, Canada, Norway	OLHDF	358	RCT	6.6	64.1 ± 14.0	40	–
		HFHD	356			64.0 ± 13.4	35
Maduell et al. [13]	Spain	OLHDF	456	RCT	3	64.5 ± 14.4	30.5	–
		HFHD	450			66.3 ± 14.3	35.8
Ok et al. [12]	Turkey	HFHD	391	RCT	2	56.5 ± 14.9	41.9	–
		OLHDF	391			56.4 ± 13.0	40.4
Imamović et al. [20]	Balkan region	HFHD	151	Retrospective cohort study	5	65 ± 12	37.7	8
		OLHDF	291			65 ± 15	36.4
Canaud et al. [14]	Europe	HFHD	795	Retrospective cohort study	5	65 ± 15	34.0	8
		OLHDF	795			65 ± 14	36.0
Djuric et al. [21]	Serbia	HFHD	32	Prospective cohort study	3	57.1 ± 9.6	71.9	8
		HDF	26			57.4 ± 10.3	53.8
Maduell et al. [18]	Spain	OLHDF	506	Retrospective cohort study	6	67.75 ± 13.32	35.6	7
		HFHD	506			67.68 ± 13.47	33.8
Morena et al. [23]	France	HFHD	191	RCT	2	76.11 ± 6.68	39.8	–
		OLHDF	190			76.35 ± 6.13	40.0
Lei [22]	China	HDF	34	RCT	6	25–75	NA	–
		HFHD	34				NA

HFHD: high-flux hemodialysis; HDF: hemodiafiltration; OLHDF: online hemodiafiltration; NA: not described.

Figure 2. Summary of risk of bias in RCTs.

Figure 3. Bias risk diagram.

Figure 4. Comparison results of all-cause mortality between HFHD and HDF.

Figure 5. Comparison of cardiovascular mortality between HFHD and HDF.

Figure 6. Comparison of infection mortality between HFHD and HDF.

Figure 7. Subgroup analysis of all-cause mortality.

Figure 8. Subgroup analysis of cardiovascular mortality.

Figure 9. Funnel plot of all-cause mortality.

Canaud B, Bragg-Gresham JL, Marshall MR, et al. Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS. Kidney Int. 2006;69(11):2087–2093.

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Vilar E, Fry AC, Wellsted D, et al. Long-term outcomes in online hemodiafiltration and high-flux hemodialysis: a comparative analysis. Clin J Am Soc Nephrol. 2009;4(12):1944–1953.

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Maduell F, Moreso F, Pons M, et al. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol. 2013;24(3):487–497.

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Ok E, Asci G, Toz H, et al. Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study. Nephrol Dial Transplant. 2013;28(1):192–202.

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Djuric PS, Jankovic A, Popovic J, et al. Survival benefit of hemodiafiltration compared with prolonged high-flux hemodialysis. Iran J Kidney Dis. 2016;10(6):388–395.

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Maduell F, Varas J, Ramos R, et al. Hemodiafiltration reduces all-cause and cardiovascular mortality in incident hemodialysis patients: a propensity-matched cohort study. Am J Nephrol. 2017;46(4):288–297.

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Morena M, Jaussent A, Chalabi L, et al. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly. Kidney Int. 2017;91(6):1495–1509.

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Data availability statement

All data generated or analyzed during this study are included in this published article.