ArticleKidney medicine2025
The Impact of Hemodiafiltration Versus Hemodialysis on Uremic Symptoms, Physical Function: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Article in Kidney medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Rationale & Objective: Uremic symptoms and frailty in kidney failure may be driven by the accumulation of uremic toxins that are variably cleared by dialysis. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the effect of hemodiafiltration (HDF) compared to hemodialysis (HD) on uremic symptoms, physical function, and quality of life (QOL). Study Design: Systematic review and meta-analysis. Setting & Study Populations: We searched Medline, EMBASE, Cochrane Library, CINAHL, and PROSPERO up to September 2024 for RCTs comparing maintenance HDF vs HD in adults with kidney failure. Selection Criteria: RCTs with the following outcomes: uremic symptoms as measured by patient-reported outcome measures (PROMs), physical function, and QOL. Data Extraction: Two reviewers independently screened abstracts and full texts, extracted data, and assessed risk of bias. Analytical Approach: Random effects meta-analysis. Results: Of 1,226 identified articles, 117 were included for full-text review, of which 24 RCTs (16 parallel, 8 crossover) met inclusion criteria. Studies were mostly from Europe or Asia and recruited a total of 2,382 participants. HDF was primarily delivered for 4 hours, 3 times weekly, in post-dilution mode (15/24 studies). The prescribed effluent dose was reported in 14 of 24 studies and ranged from 15-24 L. Uremic symptoms including cramps, fatigue, gastrointestinal symptoms, headache, neuropathy, pain, itch, restless legs, and sleep disturbance were variably reported using general or disease-specific PROMs. In meta-analyses, HDF did not improve sleep, itch, pain, fatigue, or cramps compared with HD. Meta-analyses for physical function and QOL were not performed. Limitations: RCTs were not representative of the general dialysis population, poor effluent dose reporting, lack of blinding, variability in PROMs and heterogeneity. Conclusions: The evidence for HDF over HD for uremic symptoms and physical function remains limited due to the variability in HDF/HD prescriptions and PROMs used in clinical trials, risk of bias, and heterogeneity in treatment effects. Large, adequately powered, high-quality RCTs that use standardized, validated, reliable, and responsive PROMs are needed. Registration: The protocol was registered on PROSPERO (CRD42022316562).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.