Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Fondazione Policlinico Agostino Gemelli IRCCS, University Hospital, Università Cattolica del Sacro Cuore, Rome.
Semin Dial. 2020 Mar;33(2):120-126. doi: 10.1111/sdi.12864. Epub 2020 Mar 11.
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/m (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/m (95% CI -14.5, 1.1) and -9.3 g/m (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.
在改善左心室肥厚（LVH）方面，血液透析滤过（HDF）是否优于常规血液透析（HD），定义为左心室质量指数（LVMi）降低和射血分数（EF）增加，目前尚不清楚。进行了系统的文献检索。主要结局是 LVMi 术前和术后的平均差值。次要结局是 EF 的平均差值。纳入了 7 项研究，共 845 例患者。LVMi 术前和术后的平均差值为-8.0 g/m（95%置信区间 [CI] -13.1，-2.8）。亚组分析显示，HD 和 HDF 治疗前后 LVMi 的平均差值分别为-6.7 g/m（95% CI -14.5，1.1）和-9.3 g/m（95% CI -16.3，-2.3）（P 亚组=.62）。EF 术前和术后的平均差值为 2.4%（95% CI -1.8，6.5）。亚组分析显示，HD 和 HDF 治疗前后 EF 的平均差值分别为 3.6%（95% CI -2.7，9.8）和 2.0%（95% CI 2.9，6.8）（P 亚组=.68）。元回归分析显示，年龄（Beta -0.35 ± 0.05，P <.001）和透析时间较长（Beta -0.12 ± 0.02，P <.001）与 EF 术前和术后的平均差值较低相关。与常规 HD 相比，HDF 对 LVMi 和 EF 的变化没有显著影响。
