Research Article: Effect of online hemodiafiltration compared with hemodialysis on quality of life in patients with ESRD: A systematic review and meta-analysis of randomized trials

Date Published: October 18, 2018

Publisher: Public Library of Science

Author(s): Tatsuya Suwabe, Francisco J. Barrera-Flores, Rene Rodriguez-Gutierrez, Yoshifumi Ubara, Kenmei Takaichi, Belinda Parmenter.


End-stage renal disease (ESRD) is related to high morbidity, mortality, and impaired health-related quality of life. While hemodialysis (HD) is the current life-saving standard of treatment for patients with ESRD, their quality of life (QoL) remains far from desirable. Online HDF (OL-HDF), due to its convenience, could improve the QoL of patients with ESRD, however, this remains uncertain.

We aimed to assess the body of evidence of OL-HDF compared to HD regarding QoL in patients with ESRD.

We comprehensively searched in multiple data bases from their inception to February 2018. Reviewers working independently and in duplicate appraised the quality and included randomized controlled trials (RCTs) that evaluated, in patients with ESRD and HD or OL-HDF, QoL (Short Form Health Survey with 36 questions (SF-36) with physical component score (PCS) and mental component score (MCS) as well as scores about social activity, fatigue, and emotion). A meta-analysis of each outcome of interest was performed using a random-effects model.

Six moderate quality RCTs met the inclusion criteria. Meta-analysis of 4 RCTs including a total of 1,209 patients showed that OL-HDF was associated with a lower yet non-significant score of PCS: MD (mean difference) -0.77 (95% CI -1.94 to 0.41, p = 0.20), and MCS: MD -1.25 (95% CI -3.10 to 0.59, p = 0.18); indicating a poorer QoL in patients on OL-HDF. Meta-analysis of 4 RCTs including a total of 845 patients showed OL-HDF was associated with a significant increase in the score of social activity compared to HD: SMD (standardized mean difference): 1.95 (95% CI 0.05 to 3.86, p = 0.04), indicating a better QoL in patients on OL-HDF; but regarding fatigue and emotion, there was no significant improvement when compared to HD by meta-analysis of 3 RCTs (133 patients).

The body of evidence suggests that OL-HDF does not improve QoL in patients with ESRD when compared to HD.

Partial Text

For any healthcare system, the increasing number of patients with end-stage renal disease (ESRD) is a major concern and health priority. Globally, over 2 million people receive treatment with dialysis or a kidney transplant [1], and more than 700,000 patients per year in the United States are affected by ESRD. Hemodialysis (HD) is a life-saving and the current standard of treatment for patients with ESRD. However, survival rate and quality of life (QoL) of patients in this scenario is far from desirable.

This study was conducted following guidance provided by the Cochrane Handbook for systematic reviews[18]; and it is reported in accordance to the recommendations set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) work group. The protocol of this study has been deposited in and the identifier (DOI) of this study has been assigned as




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