Frequent hemodialysis versus standard hemodialysis for people with kidney failure: Systematic review and meta-analysis of randomized controlled trials
Natale, Patrizia; Green, Suetonia C; Rose, Matthias; Bots, Michiel L; Blankestijn, Peter J; Vernooij, Robin W M; Gerittsen, Karin; Woodward, Mark; Hockham, Carinna; Cromm, Krister; Barth, Claudia; Davenport, Andrew; Hegbrant, Jörgen; Sarafidis, Pantelis; Das, Partha; Wanner, Christoph; Nissenson, Allan R; Sautenet, Benedicte; Török, Marietta; Strippoli, Giovanni
(2024) PLoS ONE, volume 19, issue 9
(Article)
Abstract
BACKGROUND: Frequent hemodialysis provided more than three times per week may lower mortality and improve health-related quality of life. Yet, the evidence is inconclusive. We evaluated the benefits and harms of frequent hemodialysis in people with kidney failure compared with standard hemodialysis. METHODS: We performed a systematic review of randomized
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controlled trials including adults on hemodialysis with highly sensitive searching in MEDLINE, Embase, CENTRAL, and Google Scholar on 3 January 2024. Data were pooled using random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. We adjudicated evidence certainty using GRADE. RESULTS: From 11,142 unique citations, only seven studies involving 518 participants proved eligible. The effects of frequent hemodialysis on physical and mental health were imprecise due to few data. Frequent hemodialysis probably had uncertain effect on death from all cause compared with standard hemodialysis (relative risk 0.79, 95% confidence interval 0.33-1.91, low certainty evidence). Data were not reported for death from cardiovascular causes, major cardiovascular events, fatigue or vascular access. CONCLUSION: The evidentiary basis for frequent hemodialysis is incomplete due to clinical trials with few or no events reported for mortality and cardiovascular outcome measures and few participants in which patient-reported outcomes including health-related quality of life and symptoms were reported.
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Keywords: Humans, Kidney Failure, Chronic/therapy, Quality of Life, Randomized Controlled Trials as Topic, Renal Dialysis, Renal Insufficiency/therapy, Journal Article, Meta-Analysis
ISSN: 1932-6203
Publisher: Public Library of Science
Note: Publisher Copyright: © 2024 Natale et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
(Peer reviewed)