Comparison of the effects of hemodialysis and hemodiafiltration on left ventricular hypertrophy in end‐stage renal disease patients: A systematic review and meta‐analysis

Abstract

Whether hemodiafiltration (HDF) is better than conventional hemodialysis (HD) in improving left ventricular hypertrophy (LVH), defined as reduction of the left ventricular mass index (LVMi) and increasing the ejection fraction (EF), is unclear. A systematic literature search was performed. Primary outcome was the mean difference between pre‐ and post‐procedural LVMi. Secondary outcome was the mean difference in EF. Seven studies with a total of 845 patients were included. The pooled mean difference between pre‐and post‐procedural LVMi was −8.0 g/m2 (95% confidence interval [CI] −13.1, −2.8). On subgroup analysis, the mean differences between pre‐ and post‐procedural LVMi for HD and HDF were −6.7 g/m2 (95% CI −14.5, 1.1) and −9.3 g/m2 (95% CI −16.3, −2.3), respectively (P for subgroups = .62). Pooled mean difference between pre‐ and post‐procedural EF was 2.4% (95% CI −1.8, 6.5). On subgroup analysis, the mean differences between pre‐ and post‐procedural EF for HD and HDF were 3.6% (95% CI −2.7, 9.8) and 2.0% (95% CI 2.9, 6.8), respectively (P for subgroups = .68). On meta‐regression, age (Beta −0.35 ± 0.05, P < .001) and longer dialysis duration (Beta −0.12 ± 0.02, P < .001) were associated with lower mean difference between pre‐and post‐procedural EF. No significant effects on changes in LVMi and EF were observed with HDF compared with conventional HD.

Clinical performance, intermediate and long‐term outcomes of high‐volume hemodiafiltration in patients with kidney failure

“…In a meta-analysis comparing cardiac outcomes of HD and HDF, in terms of LVM and ejection fraction, a similar improvement of left ventricular hypertrophy was found in patients receiving HD or OL-HDF. 30 Similarly, in a study comparing HD and OL-HDF, vascular stiffness, as assessed by pulse wave velocity, was not affected by dialysis modality. 31…”

Why should we focus on high-volume hemodiafiltration?

“…Recently, Páll et al [36] reported that T peak-end interval was lower under HDF than under HD and showed a significant correlation with LVMI. However, in a recently released meta-analysis, conventional HD and HDF showed no significant variations in the impact on the changes of LVMI and ejection fraction [37]. Hence, additional studies will be required to demonstrate whether HDF helps improve left ventricular hypertrophy to enhance survival.…”

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond

“…Although some studies suggest that endothelial function and arterial stiffness improve with the use of HDF [ 91 ], so far, it has not demonstrated a positive impact over HD in the alterations of intratherapeutic cardiac motility [ 92 ], in arterial stiffness evaluated by pulse wave velocity [ 93 ], or in the improvement in left ventricular mass and ejection fraction [ 94 ].…”