Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jan 30, 2025
Date Accepted: Jun 4, 2025
Protocol for a Systematic Review and Meta-Analysis Comparing Clearances of Polymethylmethacrylate and Polysulfone Dialyzer Membranes for Post-Dilution Hemodiafiltration in Patients with Kidney Failure
ABSTRACT
Background:
Patients with kidney failure require kidney replacement therapy (KRT) to eliminate metabolic waste. Despite being the definitive therapy, kidney transplantation is not always feasible, necessitating other KRT modalities such as hemodialysis (HD). HD can be divided into conventional HD, hemodiafiltration (HDF), and expanded HD. Due to its higher convective dose, HDF can achieve better solute clearance than conventional HD. HDF can be conducted with various dialysis membranes with differing clearance performances. Polysulfone (PS) has been used as a dialyzer membrane since 1965 due to its excellent resistance and biocompatibility. However, the newer generation of polymethylmethacrylate (PMMA) membranes also possess sufficient convective volume and minimal albumin loss.
Objective:
The forthcoming study aims to compare the solute clearance of post-dilution HDF using PMMA versus PS dialyzer membranes in patients with kidney failure requiring long-term HD.
Methods:
The literature search will use databases including PubMed, Scopus, Web of Science, Embase, and Cochrane. Two independent reviewers will select studies and assess their quality. Pooled estimates of relevant factors will be computed via a random-effects model using Stata/BE 18 software. The reporting of findings will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results:
The search and screening for the systematic literature review should be completed in October 2025. Data extraction, quality appraisal, and subsequent data synthesis will begin in November 2025. The review should be completed by April 2026, and the study results will be published in 2026.
Conclusions:
Dialyzer membrane clearance determines the HD quality. Nevertheless, many middle uremic molecules are poorly cleared with conventional HD. Consequently, HDF was invented to improve their clearance. Among the most widely used dialyzer membranes, PS and PMMA are used in the newer generation of HDF. Nevertheless, no available systematic reviews have compared the efficacy of the 2 dialyzer membrane materials. Although no ideal dialyzer can efficiently remove all types of uremic toxins while retaining essential elements, improving solute clearance should benefit patients. This information could help clinicians determine which membrane to use in HDF. Clinical Trial: PROSPERO CRD42024603277 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024603277
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