A Meta-analysis Of Hemodiafiltrationin Therapy In Improving Anemia In Maintenance Hemodialysis Patients

Objective:To assess the efficacy of hemodiafiltration versus hemodialysis in the correction of patients who have chronic renal failure and anemia.Methods:VIP?VIP??Chinese Biomedical Literature Database?CBWMDisc??wangfang?wangfang??China HowNet?CNKI??PubMed?EmBase?Cochrane Library?Web of science?Clinical trials.gov,have been searched from website building to November 1,2018.We assessed the quality of the included studies by the Cochrane bias risk assessment tool.We used the relative risk?RR?to combine the effect size,the mean difference?MD?to combine the measurement data,the standardized mean difference?SMD?to combine the measurement data when there is a large difference in value.We use RevMan 5.3 and Stata 12 to analyze the extracted data.Result:?1?Hemodiafiltration was superior to the hemodialysis in improving the hemoglobin of the patients?MD=7.15,95%CI[3.16,11.15]?,the difference was statistically significant?P=0.0005?;?2?Hemodiafiltration was superior to the hemodialysis in improving the hematocri of the patients?MD=3.28,95%CI[0.68,5.88]?,the difference was statistically significant?P=0.01?;?3?Hemodiafiltration did not differ from hemodialysis in affecting serum albumin of the patients?MD=-0.56,95%CI[-2.42,1.29]?,the difference was not statistically significant?P=0.55?;?4?Hemodiafiltration did not differ from hemodialysis clearing blood urea nitrogen in the patients?MD=-1.51,95%CI[-5.02,2]?,the difference was not statistically significant?P=0.4?;?5?Hemodiafiltration did not differ from hemodialysis in clearing serum creatinine in the patients?SMD=-0.06,95%CI[-0.20,0.07]?,the difference was not statistically significant?P=0.37?;?6?Hemodiafiltration was superior to hemodialysis in clearing parathyroid hormone in the patients?SMD=-0.54,95%CI[-0.79,-0.29]?,the difference was statistically significant?P=0?;?7?Hemodiafiltration was superior to hemodialysis in clearing blood?₂ microglobulin in the patients?MD=-5.89,95%CI[-10.78,-1.00]?,the difference was statistically significant?P=0.02?;?8?Hemodiafiltration was superior to hemodialysis in clearing blood c-reactive protein in the patients?MD=-3.54,95%CI[-5.84,-1.25]?,the difference was statistically significant?P=0.002?;?9?Hemodiafiltration was superior to hemodialysis in clearing blood interleukin-6 in the patients?SMD=-0.98,95%CI[-1.62,-0.33]?,the difference was statistically significant?P=0.003?;?10?Hemodiafiltration did not differ from hemodialysis in improving the survival rate of the patients?HR=0.70,95%CI[0.42,1.19]?,the difference was no statistically significant?P=0.19??Conclusions:Hemodiafiltration was superior to hemodialysis in improving patients'hemoglobin,hematocrit,removing parathyroid hormone,?₂ microglobulin,c-reactive protein and interleukin-6,while there was no significant difference in removing patients'serum creatinine,blood urea nitrogen,changing serum albumin and improving survival rate.The reason of improving anemia in patients with hemodialysis filtration may be related to the clearance of large molecules and inflammatory factors such as parathyroid hormone.