"Dialysis Dose and the Effect of Membrane Flux in Maintenance Hemodialysis".The New England Journal of Medicine. 2002. 347(25):2010-2019.
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9 Funding 10 Further Reading
Among patients undergoing maintenance hemodialysis, does increasing the dose of dialysis or using a high-flux dialyzer membrane improve survival or reduce morbidity?
Among patients undergoing maintenance hemodialysis, neither increased dose of dialysis beyond the current U.S. recommended levels nor the use of high-flux membranes substantially improves survival or reduces morbidity when compared to a standard dose and low-flux membranes.
There has been uncertainty about whether higher doses of dialysis or higher flux dialyzer membranes would improve outcomes in patients undergoing maintenance hemodialysis. Hemodialysis (HEMO) Study, a randomized clinical trial, assessed the effects of dialysis dose and membrane flux on patient outcomes.
Current U.S. practice guidelines recommend a single-pool Kt/V of at least 1.24 but do not specifically recommend for or against the routine use of high-flux membranes.
Multicenter, double-blind, randomized, two-by-two factorial clinical trial N=1,846 patients undergoing thrice-weekly in-center hemodialysis Intervention groups: Standard dose of dialysis (equilibrated Kt/V ~1.16) vs. high dose of dialysis (equilibrated Kt/V ~1.53) Low-flux dialyzer (beta2-microglobulin clearance ~3 mL/min) vs. high-flux dialyzer (beta2-microglobulin clearance ~34 mL/min)
Inclusion Criteria: Patients aged 18 to 80 undergoing thrice-weekly in-center hemodialysis for ≥3 months Exclusion Criteria: Serum albumin <2.6 g/dL, residual urea clearance >1.5 mL/min per 35 liters or inability to achieve equilibrated Kt/V >1.30 within 4.5 hours in test runs Baseline Characteristics: Predominance of urban centers; high rates of hypertension (96%), diabetes (45%), and cardiac disease (80%)
Randomized 1:1 ratio to either a standard-dose or high-dose goal and to dialysis with either a low-flux or high-flux dialyzer.
Primary Outcome: Death from any cause: no significant difference between dose groups (RR 0.96, 95% CI 0.84 to 1.10, P=0.53) or between flux groups (RR 0.92, 95% CI 0.81 to 1.05, P=0.23) Secondary Outcomes: Hospitalizations for cardiac causes or death, hospitalizations for infection or death, decline in serum albumin levels or death, and hospitalizations not related to vascular access: no significant difference between dose or flux groups Possible benefits of dose or flux interventions suggested in subgroups of patients
Supported by the National Institute of Diabetes and Digestive and Kidney Diseases with additional support from Baxter Healthcare, Fresenius Medical Care, R&D Laboratories, and Ross Laboratories.
For additional information on the study and its implications, readers are directed to associated NEJM publications and the study's report in PubMed and other medical literature databases.