Comparison of the impact of hemodialysis versus hemofiltration on filter lifespan in acute kidney injury: A meta-analysis

Abstract

Objective:

To compare the effect of hemofiltration (HF) versus hemodialysis (HD) on mortality and filter lifespan in patients with acute kidney injury (AKI).

Methods:

Literature published between January 1990 and December 2025 was retrieved from four databases: PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI). Statistical analyses were performed using Review Manager (RevMan) software.

Results:

Eight randomized controlled trials were included. HD showed no statistically significant difference in all-cause mortality compared to HF (RR = 1.07, 95% CI: 0.82–1.40). In subgroup analyses, continuous renal replacement therapy hemodialysis (CRRT-HD) showed no statistically significant difference in mortality compared to HF (RR = 1.05, 95% CI: 0.80–1.39; p = 0.71), nor did intermittent hemodialysis (IHD; RR = 1.19, 95% CI: 0.96–1.49; p = 0.12). Regarding filter lifespan, no significant difference was found in the overall analysis (SMD = 0.46, 95% CI: −0.29 to 1.22). However, in a single study under matched treatment doses, HD significantly prolonged filter lifespan (SMD = 1.00, 95% CI: 0.47–1.53). No significant difference was found between HDF and HF (SMD = −0.10, 95% CI: −0.37 to 0.18).

Conclusion:

Current evidence shows no significant difference in mortality between HF and HD for AKI. Under matched doses, HD showed a significant advantage in prolonging filter lifespan, but this finding is based on a single study and requires confirmation. The evidence remains limited, highlighting the need for large-scale trials to assess patient-centered outcomes and operational indicators like filter lifespan.