High cut-off membranes in patients requiring renal replacement therapy: a systematic review and meta-analysis

BACKGROUND: Whether high cut-off (HCO) membranes are more effective than high-flux (HF) membranes in patients requiring renal replacement therapy (RRT) remains controversial. The aim of this systematic review was to investigate the efficacy of HCO membranes regarding the clearance of inflammation-related mediators, β2-microglobulin and urea; albumin loss; and all-cause mortality in patients requiring RRT. METHODS: We searched all relevant studies on PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure, with no language or publication year restrictions. Two reviewers independently selected studies and extracted data using a prespecified extraction instrument. Only randomized controlled trials (RCTs) were included. Summary estimates of standardized mean differences (SMDs) or weighted mean differences (WMDs) and risk ratios (RRs) were obtained by fixed-effects or random-effects models. Sensitivity analyses and subgroup analyses were performed to determine the source of heterogeneity. RESULTS: Nineteen RCTs involving 710 participants were included in this systematic review. Compared with HF membranes, HCO membranes were more effective in reducing the plasma level of interleukin-6 (IL-6) (SMD −0.25, 95% confidence interval (CI) −0.48 to −0.01, P = 0.04, I(2) = 63.8%); however, no difference was observed in the clearance of tumor necrosis factor-α (TNF-α) (SMD 0.03, 95% CI −0.27 to 0.33, P = 0.84, I(2) = 4.3%), IL-10 (SMD 0.22, 95% CI −0.12 to 0.55, P = 0.21, I(2) = 0.0%), or urea (WMD −0.27, 95% CI −2.77 to 2.23, P = 0.83, I(2) = 19.6%). In addition, a more significant reduction ratio of β(2)-microglobulin (WMD 14.8, 95% CI 3.78 to 25.82, P = 0.01, I(2) = 88.3%) and a more obvious loss of albumin (WMD −0.25, 95% CI −0.35 to −0.16, P < 0.01, I(2) = 40.8%) could be observed with the treatment of HCO membranes. For all-cause mortality, there was no difference between the two groups (risk ratio [RR] 1.10, 95% CI 0.87 to 1.40, P = 0.43, I(2) = 0.0%). CONCLUSIONS: Compared with HF membranes, HCO membranes might have additional benefits on the clearance of IL-6 and β2-microglobulin but not on TNF-α, IL-10, and urea. Albumin loss is more serious with the treatment of HCO membranes. There was no difference in all-cause mortality between HCO and HF membranes. Further larger high-quality RCTs are needed to strengthen the effects of HCO membranes.