目的 分析在线血液透析滤过（online hemodiafiltration,OL-HDF）能否改善维持性血液透析（maintenance hemodialysis , MHD）患者生存率。方法 检索了Pubmed/MEDLINE、EMBASE和Cochrane Library 电子数据库的OL-HDF对MHD患者生存率影响的随机对照试验（randomized controlled trials,RCT）,前瞻性对照研究（prospective controlled trials,PCT）和前瞻性队列研究（prospective cohort study）,使用优势比进行计算。结果 3个 RCT ，1个PCT和1个前瞻性队列研究共 5009名患者纳入本次研究，5个研究均比较了在线血液透析滤过与血液透析（高通量透析，HFHD或低通量透析，LFHD）对患者生存率的影响。与透析组比较，OL-HDF组患者生存率没有得到改善，进一步以OL-HDF过程中置换液量进一步分组分析，高效率OL-HDF（high volume OL-HDF） 组患者较HD组患者生存率明显得到改善（OR=0.53,Z=5.51,P<0.00001,I2=38%）；低效OL-HDF在降低死亡率方面与HD组患者比较无明显差异（OR=1.0,Z=0.01,P=0.99,I2=0%）。结论 高效率OL-HDF可降低MHD 患者死亡率，并与OL-HDF 置换液剂量相关。

Objective To evaluate the effect of online hemodiafiltration(OL-HDF)in the survival rate of maintenance hemodilysis(MHD) patients.Methods Randomized controlled trials(RCT),prospective controlled trials(PCT) and prospective cohort trials studying the effect of OL-HDF on survival rate of MHD patients were searched in the Pubmed /Medline, EMBASE、and Cochrane Library electronic databases, then the odds ratio was calculated. Results 5009 patients were included in this study: the effect of survival rate was compared in the OL-HDF and HD group. Compared with the HD group, the survival rate of OL-HDF group wasn not improved (Fixed effect model, OR=0.53,Z=5.51,P<0.00001,I2=38%). The subgroup of OL-HDF patients treated with a high substitution volume per session had better overall mortality compared with the HD group. There were no significant difference of overall mortality rate between low volume OL-HDF group and HD group（OR=1.0,Z=0.01,P=0.99,I2=0%）. Conclusions High volume OL-HDF may not improve the survival rate of MHD patients, associated with OL-HDF substitution volume.