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

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.