[en] The effect of high-flux hemodialysis membranes on patient survival has not been unequivocally determined. In this prospective, randomized clinical trial, we enrolled 738 incident hemodialysis patients, stratified them by serum albumin 4 and 4 g/dl, and assigned them to either low-flux or high-flux membranes. We followed patients for 3 to 7.5 yr. Kaplan-Meier survival analysis showed no significant difference between high-flux and low-flux membranes, and a Cox proportional hazards model concurred. Patients with serum albumin 4 g/dl had significantly higher survival rates in the high-flux group compared with the low-flux
group (P 0.032). In addition, a secondary analysis revealed that high-flux membranes may significantly improve survival of patients with diabetes. Among those with serum albumin 4 g/dl, slightly different effects among patients with and without diabetes suggested a potential interaction between diabetes status and low serum albumin in the reduction of risk conferred by high-flux membranes. In summary, we did not detect a significant survival benefit with either high-flux or low-flux membranes in the population overall, but the use of high-flux membranes conferred a significant survival benefit among patients with serum albumin
4 g/dl. The apparent survival benefit among patients who have diabetes and are treated with high-flux membranes requires confirmation given the post hoc nature of our analysis.
Yoshino M, Kuhlmann MK, Kotanko P, Greenwood RN, Pisoni RL, Port FK, Jager KJ, Homel P, Augustijn H, de Charro FT, Collart F, Erek E, Finne P, Garcia-Garcia G, Gronhagen-Riska C, loannidis GA, Ivis F, Leivestad T, Lokkegaard H, Lopot F, Jin DC, Kramar R, Nakao T, Nandakumar M, Ramirez S, Van der Sande FM, Schon S, Simpson K, Walker RG, Zaluska W, Levin NW: International differences in dialysis mortality reflect background general population atherosclerotic cardiovascular mortality. J Am Soc Nephrol 17: 3510-3519, 2006
Boure T, Vanholder R: Biochemical and clinical evidence for uremic toxicity. Artif Organs 28: 248-253, 2004
Weissinger EM, Kaiser T, Meert N, De Smet R, Walden M, Mischak H, Vanholder RC: Proteomics: A novel tool to unravel the patho-physiology of uraemia. Nephrol Dial Transplant 19: 3068-3077, 2004
Hornberger JC, Chernew M, Petersen J, Garber AM: A multivariate analysis of mortality and hospital admissions with high-flux dialysis. J Am Soc Nephrol 3: 1227-1237, 1992
Bloembergen WE, Hakim RM, Stannard DC, Held PJ, Wolfe RA, Agodoa LY, Port FK: Relationship of dialysis membrane and cause-specific mortality. Am J Kidney Dis 33: 1-10, 1999
Locatelli F, Mastrangelo F, Redaelli B, Ronco C, Marcelli D, La Greca G, Orlandini G: Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters. The Italian Cooperative Dialysis Study Group. Kidney Int 50: 1293-1302, 1996
Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R: Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347: 2010-2019, 2002
Cheung AK, Levin NW, Greene T, Agodoa L, Bailey J, Beck G, Clark W, Levey AS, Leypoldt JK, Ornt DB, Rocco MV, Schulman G, Schwab S, Teehan B, Eknoyan G: Effects of high-flux hemodialysis on clinical outcomes: Results of the HEMO study. J Am Soc Nephrol 14: 3251-3263, 2003
Delmez JA, Yan G, Bailey J, Beck GJ, Beddhu S, Cheung AK, Kaysen GA, Levey AS, Sarnak MJ, Schwab SJ: Cerebrovascular disease in maintenance hemodialysis patients: results of the HEMO Study. Am J Kidney Dis 47: 131-138, 2006
Locatelli F, Hannedouche T, Jacobson S, La Greca G, Loureiro A, Martin-Malo A, Papadimitriou M, Vanholder R: The effect of membrane permeability on ESRD: Design of a prospective randomised multicentre trial. J Nephrol 12: 85-88, 1999
Pifer TB, McCullough KP, Port FK, Goodkin DA, Maroni BJ, Held PJ, Young EW: Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int 62: 2238-2245, 2002
Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM: The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 329: 1001-1006, 1993
Locatelli F, Port FK, Pisoni RL, Martin-Malo A, Papadimitriou M, Van-holder R, Hannedouche T, Jacobson SH, Ronco C, Loureiro AC, Wizemann V: Patient and treatment characteristics in the MPO study: Validation against the DOPPS population [Abstract]. Nephrol Dial Transplant 18[Suppl 4]:196, 2003
Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, Saito A, Rayner HC, Kurokawa K, Port FK, Held PJ, Young EW: Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol 14: 3270-3277, 2003
Port FK, Wolfe RA, Hulbert-Shearon TE, Daugirdas JT, Agodoa LY, Jones C, Orzol SM, Held PJ: Mortality risk by hemodialyzer reuse practice and dialyzer membrane characteristics: Results from the USRDS dialysis morbidity and mortality study. Am J Kidney Dis 37: 276-286, 2001
Chauveau P, Nguyen H, Combe C, Chene G, Azar R, Cano N, Canaud B, Fouque D, Laville M, Leverve X, Roth H, Aparicio M: Dialyzer membrane permeability and survival in hemodialysis patients. Am J Kidney Dis 45: 565-571, 2005
Krane V, Krieter DH, Olschewski M, Marz W, Mann JF, Ritz E, Wanner C: Dialyzer membrane characteristics and outcome of patients with type 2 diabetes on maintenance hemodialysis. Am J Kidney Dis 49: 267-275, 2007
van Dijk PC, Jager KJ, Stengel B, Gronhagen-Riska C, Feest TG, Briggs JD: Renal replacement therapy for diabetic end-stage renal disease: Data from 10 registries in Europe (1991-2000). Kidney Int 67: 1489-1499, 2005
Stenvinkel P: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55: 1899-1911, 1999
The DOPPS Report, 2004. Available at: http://www.dopps.org/pdf/dopps- report-2004.pdf. Accessed June 30, 2007
Cheung AK, Rocco MV, Yan G, Leypoldt JK, Levin NW, Greene T, Agodoa L, Bailey J, Beck GJ, Clark W, Levey AS, Ornt DB, Schulman G, Schwab S, Teehan B, Eknoyan G: Serum beta-2 microglobulin levels predict mortality in dialysis patients: Results of the HEMO study. J Am Soc Nephrol 17: 546-555, 2006
Cheung AK, Greene T, Leypoldt JK, Yan G, Allon M, Delmez J, Levey AS, Levin NW, Rocco MV, Schulman G, Eknoyan G: Association between serum 2-microglobulin level and infectious mortality in hemodialysis patients. Clin J Am Soc Nephrol 3: 69-77, 2008
Daugirdas JT: Second generation logarithmic estimates of single-pool variable volume Kt/V: An analysis of error. J Am Soc Nephrol 4: 1205-1213, 1993
European Best Practice Guidelines Expert Group on Hemodialysis ERA: Section IV. Dialysis Fluid Purity. Nephrol Dial Transplant 17[Suppl 7]: 45-62, 2002
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 40: 373-383, 1987
Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML: A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 108: 609-613, 2000
