The efficacy and safety of high flux hemodialysis and hemodiafiltration in patients with end-stage renal disease: a meta-analysis of randomized controlled trials

Objective To compare the differences in clinical efficacy and adverse effects between high flux hemodialysis (HFHD) and hemodiafiltration (HDF) in patients with end-stage renal disease. Methods The databases of CNKI, Chinese biomedical literature database, Wei Pu database, Wang Fang database, Cochrane Library, PubMed, EMBASE and Web of Science were indexed to collect randomized controlled trials (RCTs) published up to February 28, 2018. After data extraction, literatures selection and quality evaluation, Rev Man 5.3 was performed for meta-analysis. Results A total of 1802 patients in 14 RCTs were included in this study. HFHD further reduced serum levels of phosphate (SMD=-0.50,95%CI:-0.89——0.12,P=0.01) and parathyroid hormone (SMD=-1.31, 95%CI:-2.06-0.57, P=0.000 6) compared with HDF. The serum calcium level in HFHD was significantly higher than in HDF (SMD=0.25, 95%CI:0.03-0.48, P=0.03), while serum calcium levels were increased in both groups. There were no significant differences between the two groups in the serum levels of BUN, creatinine, hemoglobin, beta2-microglobulin, albumin, CRP and LDL-C. The incidence of adverse event showed no significant differences between the two groups, including hypotension, hypertension, arrhythmia, heart failure and hemorrhage. Conclusions Both HFHD and HDF can significantly remove the body toxins in patients with chronic uremia, which has good safety and tolerability. However, HFHD can lead to a greater benefit for patients than HDF in calcium-phosphorus metabolism.