Prognosis And Clinical Complications Of Twice-weekly Hemodialysis:a Systematic Review And Meta-analysis

Purpose Twice-weekly hemodialysis is widespread in developing countries,but so far its prognosis and dialysis adequacy is inconclusive,this article aims to systematically analyze the existing research to compare effect of twice-weekly hemodialysis and thrice-weekly hemodialysis on the prognosis and clinical complications.Methods Two researchers searching PubMed,EMBASE respectively from the building to October 2017 in accordance with the include exclusion standard screening and evaluation of literature and data extraction,controversial place please third researchers evaluation and decision after consultation.Statistical analysis was performed using stata12.0,and the continuous variables were combined with the weighted average combined with statistics.The second classification variables were combined with RR,and each effect was expressed in a 95%confidence interval.Cochran Q test was used for heterogeneity analysis,and P>0.1 indicated that there was no significant difference in heterogeneity test,and the homogeneity of the study was better,and I~2 value was used to quantitatively evaluate the heterogeneity of the literature.If the inclusion literature has homogeneity(I~2<50%),the effect size of fixed effect model is adopted.When there is heterogeneity analysis(I~2>50%)in the literature,the sensitivity analysis or subgroup analysis is used to find the heterogeneity source.When the data must be synthesized,the random effect model is used to combine the effect quantity.Results We finally included nine studies that met the inclusion criteria,which all were cohort studies,five were prospective cohort studies,and four were retrospective cohort studies.Including 8 English literatures and 1Spanish literature,eight studies were included in quantitative analysis,nine studies were included in qualitative analysis.A total of 2286 ESRD patients were treated with hemodialysis twice a week,and 12,967 ESRD patients were treated with hemodialysis three times a week.This paper analyzes the two kinds of hemodialysis scheme of prognostic indicators such as all-cause mortality and hospitalization rates,as well as anemia management,bone mineral metabolism,nutrition,cardiovascular diseases that reflect the dialysis adequacy index.The study found that all-cause mortality,hemoglobin levels,blood calcium,blood phosphorus,blood parathyroid hormone levels,serum albumin levels had no statistical difference between the two groups blood,normalized protein catabolic rate has little difference between two groups(WMD 0.13,95%CI,0.16 to 0.09,g/kg/day).Conclusions Twice-weekly dialysis has noninferior mortality compared with thrice-weekly dialysis,and it may serve as a valid option for selected patients.However,there are many confounding factors affecting the prognosis and adequancy of dialysis,and more randomized controlled trials or large,high-quality prospective cohort studies are needed to obtain higher quality evidence.