Meta-Analysis

. 2024 Sep 6;19(9):e0309773.

doi: 10.1371/journal.pone.0309773. eCollection 2024.

Frequent hemodialysis versus standard hemodialysis for people with kidney failure: Systematic review and meta-analysis of randomized controlled trials

Patrizia Natale^{1

2

3}, Suetonia C Green⁴, Matthias Rose⁵, Michiel L Bots⁶, Peter J Blankestijn⁷, Robin W M Vernooij^{6

7}, Karin Gerittsen⁷, Mark Woodward^{8

9}, Carinna Hockham⁹, Krister Cromm^{5

10}, Claudia Barth¹¹, Andrew Davenport¹², Jörgen Hegbrant¹³, Pantelis Sarafidis¹⁴, Partha Das¹, Christoph Wanner^{15

16}, Allan R Nissenson^{17

18}, Benedicte Sautenet¹⁹, Marietta Török²⁰, Giovanni Strippoli^{1

2}

Affiliations

¹ Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
² Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J) University of Bari Aldo Moro, Bari, Italy.
³ Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
⁴ Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
⁵ Department of Psychosomatic Medicine, Center for Patient-Centered Outcomes Research (CPCOR), Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁶ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁷ Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
⁸ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
⁹ The George Institute for Global Health, Imperial College, London, United Kingdom.
¹⁰ Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg v.d.H, Germany.
¹¹ B. Braun Avitum AG, Medical Scientific Affairs, Melsungen, Germany.
¹² Department of Nephrology, University College of London, London, United Kingdom.
¹³ Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden.
¹⁴ Department of Nephrology, Aristotle University, Hippokration Hospital, Thessaloniki, Greece.
¹⁵ Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany.
¹⁶ Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
¹⁷ DaVita International, London, United Kingdom.
¹⁸ David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, United States of America.
¹⁹ Department Nephrologie-Hypertension Arterielle, Dialyses, Transplantation Renale, Tours, France.
²⁰ Diaverum Renal Services Group, Budapest, Hungary.

PMID: 39240930
PMCID: PMC11379176
DOI: 10.1371/journal.pone.0309773

Meta-Analysis

Frequent hemodialysis versus standard hemodialysis for people with kidney failure: Systematic review and meta-analysis of randomized controlled trials

Patrizia Natale et al. PLoS One. 2024.

. 2024 Sep 6;19(9):e0309773.

doi: 10.1371/journal.pone.0309773. eCollection 2024.

Authors

Affiliations

¹ Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
² Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J) University of Bari Aldo Moro, Bari, Italy.
³ Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
⁴ Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
⁵ Department of Psychosomatic Medicine, Center for Patient-Centered Outcomes Research (CPCOR), Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁶ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁷ Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
⁸ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
⁹ The George Institute for Global Health, Imperial College, London, United Kingdom.
¹⁰ Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg v.d.H, Germany.
¹¹ B. Braun Avitum AG, Medical Scientific Affairs, Melsungen, Germany.
¹² Department of Nephrology, University College of London, London, United Kingdom.
¹³ Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden.
¹⁴ Department of Nephrology, Aristotle University, Hippokration Hospital, Thessaloniki, Greece.
¹⁵ Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany.
¹⁶ Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
¹⁷ DaVita International, London, United Kingdom.
¹⁸ David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, United States of America.
¹⁹ Department Nephrologie-Hypertension Arterielle, Dialyses, Transplantation Renale, Tours, France.
²⁰ Diaverum Renal Services Group, Budapest, Hungary.

PMID: 39240930
PMCID: PMC11379176
DOI: 10.1371/journal.pone.0309773

Erratum in

Correction: Frequent hemodialysis versus standard hemodialysis for people with kidney failure: Systematic review and meta-analysis of randomized controlled trials.
Natale P, Green SC, Rose M, Bots ML, Blankestijn PJ, Vernooij RWM, Gerritsen KGF, Woodward M, Hockham C, Cromm K, Barth C, Davenport A, Hegbrant J, Sarafidis P, Das P, Wanner C, Nissenson AR, Sautenet B, Török M, Strippoli G. Natale P, et al. PLoS One. 2025 Sep 15;20(9):e0332338. doi: 10.1371/journal.pone.0332338. eCollection 2025. PLoS One. 2025. PMID: 40952994 Free PMC article.

Abstract

Background: Frequent hemodialysis provided more than three times per week may lower mortality and improve health-related quality of life. Yet, the evidence is inconclusive. We evaluated the benefits and harms of frequent hemodialysis in people with kidney failure compared with standard hemodialysis.

Methods: We performed a systematic review of randomized controlled trials including adults on hemodialysis with highly sensitive searching in MEDLINE, Embase, CENTRAL, and Google Scholar on 3 January 2024. Data were pooled using random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. We adjudicated evidence certainty using GRADE.

Results: From 11,142 unique citations, only seven studies involving 518 participants proved eligible. The effects of frequent hemodialysis on physical and mental health were imprecise due to few data. Frequent hemodialysis probably had uncertain effect on death from all cause compared with standard hemodialysis (relative risk 0.79, 95% confidence interval 0.33-1.91, low certainty evidence). Data were not reported for death from cardiovascular causes, major cardiovascular events, fatigue or vascular access.

Conclusion: The evidentiary basis for frequent hemodialysis is incomplete due to clinical trials with few or no events reported for mortality and cardiovascular outcome measures and few participants in which patient-reported outcomes including health-related quality of life and symptoms were reported.

Copyright: © 2024 Natale et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

See this image and copyright information in PMC

References

1. Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet. 2018;392(10159):2052–90. doi: 10.1016/S0140-6736(18)31694-5 - DOI - PMC - PubMed
1. Bello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, et al. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022;18(6):378–95. doi: 10.1038/s41581-022-00542-7 - DOI - PMC - PubMed
1. Bello A, Okpechi I, Levin A, Ye F, Saad S, Zaidi D, et al. A report by the International Society of Nephrology: An Assessment of Global Kidney Health Care Status focussing on Capacity, Availability, Accessibility, Affordability and Outcomes of Kidney Disease. Inter Soc Nephrol, Brussels, Belgium. 2023.
1. Bello AK, Levin A, Tonelli M, Okpechi IG, Feehally J, Harris D, et al. Assessment of Global Kidney Health Care Status. JAMA. 2017;317(18):1864–81. doi: 10.1001/jama.2017.4046 - DOI - PMC - PubMed
1. Murtagh FEM, Addington-Hall J, Higginson IJ. The prevalence of symptoms in End-Stage Renal Disease: A systematic review. Adv Chronic Kidney Dis. 2007;14(1):82–99. doi: 10.1053/j.ackd.2006.10.001 - DOI - PubMed

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Frequent hemodialysis versus standard hemodialysis for people with kidney failure: Systematic review and meta-analysis of randomized controlled trials

Affiliations

Frequent hemodialysis versus standard hemodialysis for people with kidney failure: Systematic review and meta-analysis of randomized controlled trials

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources