Medizinischer Zusatznutzen von Hämodiafiltration gegenüber Hämodialyse bezüglich Mortalität und Lebensqualität: Eine systematische Übersicht

Abstract

Background: Patients with end-stage renal diesease are dependent on chronic renal replacement therapy. Outcomes regarding the clinical benefits of hemodiafiltration (HDF) compared to hemodialysis (HD) have been inconclusive so far. The aim of this systematic review is to evaluate the effect of HDF on all-cause mortality and quality of life compared to HD. Methods: A systematic review of published literature was conducted using two bibliographic databases and two trial registers. The review was conducted in September and October 2013. Results: The search yielded 14 relevant studies. Out of 3 large randomized controlled trials reporting the outcome mortality, 1 reported a significantly lower mortality in the HDF-arm; the other 2 did not show significant differences between arms. 1 large randomized controlled trial reporting the outcome quality-of-life was identified, no significant differences were reported. The remaining body of evidence was assessed as non-robust. Discussion: A positive influence of HDF on overall survival appears probable if high-volume fluid exchange is achieved. Only one large randomized controlled trial reports significantly lower overall mortality after treatment with HDF for all patients. There is no reliable evidence for better quality-of-life after treatment with HDF.