Effectiveness and safety of different hemodialysis modalities: a review.
OBJECTIVE
At present, there are a number of hemodialysis (HD) modalities that appear to be superior to conventional HD. This study sought to compare and assess the effectiveness and safety of the various hemodialysis modalities.


METHODS



METHODS
multiple electronic databases were searched, including Medline, EMBASE and Cochrane Collaboration. Papers were independently selected by 2 researchers.


RESULTS
Thirty-five original papers were included. The outcomes of the largest randomized clinical trial undertaken (the Hemodialysis [HEMO] Study) showed that high- versus low-flux HD did not significantly reduce overall mortality (p=0.23) but did reduce the risk of hospitalization and death due to vascular causes by 10% (p<0.05). The results of the respective studies are controversial as to the benefits of high-flux HD on anemia, nutritional status or cardiovascular risk factors. The only study that provided mortality results for hemodiafiltration failed to observe significant differences between high- and low-flux HD. Similarly, there was no clear evidence of improvements in any of the other outcomes investigated.


CONCLUSIONS
The results of this review do not allow for any conclusion to be drawn as to which HD modality is best in terms of mortality, morbidity and patients' quality of life. The different HD techniques do not show major improvements in any of the outcomes assessed, but these cannot be dismissed since the studies had multiple flaws and lacked long-term follow-up data. Better-quality studies are needed to establish which hemodialysis modalities are best suited to individual patients' specific clinical conditions.
Varela Lema
Leinir
L
Galician Agency for Health Technology Assessment, Galician Health Service, Santiago de Compostela - Spain.
Ruano Raviña
Alberto
A
D017583:Hemodiafiltration / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D018579:Patient Selection; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012107:Research Design; D016896:Treatment Outcome