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

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.