The edition · Nephrology
Cochrane update: convective dialysis likely lowers death and cardiovascular death against haemodialysis
The third version of the review rates the mortality benefit at moderate certainty. Also: chronic hypoparathyroidism and heart attack risk, and a self-management trial in diabetes at risk of kidney disease.
The edition in brief
Today's nephrology edition closes on the updated Cochrane review of haemodiafiltration, haemofiltration and haemodialysis. Across 62 randomised trials and 6,897 adults with kidney failure, convective dialysis likely reduced all-cause death (RR 0.88, 0.80 to 0.96; 15 trials) and cardiovascular death (RR 0.78, 0.66 to 0.92; 9 trials), both with no heterogeneity and moderate certainty. Effects on non-fatal cardiovascular events, fatigue, access problems, hospital admission and quality of life were inconclusive. A meta-analysis of nine cohort studies with 134,598 people found chronic hypoparathyroidism associated with a higher hazard of myocardial infarction (HR 1.19, 1.06 to 1.35); associations with heart failure, arrhythmia, stroke and death were heterogeneous and lost significance on prediction intervals. A single-centre Chinese trial of 134 people with type 2 diabetes at high risk of kidney disease reported better HbA1c, eGFR, systolic pressure and LDL cholesterol after 12 weeks of structured self-management, but no change in albuminuria. The pearl covers how to read a falling eGFR after starting an SGLT2 inhibitor or RAAS blocker.
Chronic hypoparathyroidism was linked to a higher risk of heart attack
Treat chronic hypoparathyroidism as a cardiovascular risk state: assess risk factors and avoid over-replacement of calcium and vitamin D.
Structured self-management moved risk factors in diabetes at risk of kidney disease, but not albuminuria
Pair structured self-management education with proven kidney-protective drugs in type 2 diabetes at risk of kidney disease.
An early eGFR dip after an SGLT2 inhibitor or RAAS blocker is expected
Do not stop an SGLT2 inhibitor or RAAS blocker for an early eGFR dip of up to about 30%; recheck and look for other causes if it falls further.
Haemodiafiltration likely lowers death compared with haemodialysis, says Cochrane update
Where facilities allow, consider haemodiafiltration as the default for adults on maintenance dialysis, given its likely survival benefit.
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