"Morbidity Effects of Hemodialysis Dose and Membrane Flux". The New England Journal of Medicine. 1981. 305(20):1176-1181.
Links to original sources: Wiki Journal Post Full Journal Article
Does the prescription of hemodialysis treatment regarding dialysis dose (as indicated by blood urea nitrogen levels) and duration affect patient morbidity?
Prescriptions associated with relatively high blood urea nitrogen (BUN) levels appear to increase morbidity, while prescriptions emphasizing more efficient removal of urea, given adequate dietary protein and nutrient intake, may decrease morbidity.
The National Cooperative Dialysis Study (NCDS) compared morbidity outcomes based on different hemodialysis prescription parameters: high or low BUN concentration and long or short dialysis times. Researchers found a higher morbidity rate, including hospitalizations and medical withdrawals, among groups receiving a dialysis prescription with a relatively high target BUN concentration, regardless of treatment duration.
The findings sparked discussion in the medical community on the adequacy of dialysis prescriptions and influenced subsequent research focusing on dialysis dose parameters. However, current guidelines on this specific issue are not discussed in the article.
- Multicenter, randomized controlled trial - N=151 patients undergoing hemodialysis treatment - Randomized to one of four treatment groups based on BUN levels and dialysis times: Group I: Long time, low BUN Group II: Long time, high BUN Group III: Short time, low BUN Group IV: Short time, high BUN - Setting: 8 centers - Enrollment period not specified - Follow-up at least three months up to 22 months
- Inclusion Criteria: Aged 18-70 years, undergoing hemodialysis in a center, residual creatinine clearance ≤3 ml/min - Exclusion Criteria: Known cancer, diabetes mellitus, uncontrolled hypertension, reversible renal failure, systemic disease like lupus, severe pulmonary or hepatic dysfunction - Baseline Characteristics: Not discussed in detail
- Patients received hemodialysis using a prescribed dialyzer and were later randomly assigned to one of the groups. - Dietary protein intake was prescribed to be between 0.8 to 1.4 g/kg of body weight daily. - Target BUN concentrations and treatment durations were controlled for using specific hemodialyzers and adjustment of dialysis parameters.
- Primary Outcomes: Major organ-system indexes, psychosocial data, and general morbidity measures, including death, hospitalizations, and study withdrawal - Secondary Outcomes: Not specified
- The physicians and patient-care personnel were not blinded in the study, which could introduce bias in the interpretation of the need for hospitalization and the judgment of patient withdrawal for medical reasons.
Supported under a contract (NO-l-AM-6–2207) from the National Institute of Arthritis, Metabolism, and Digestive Diseases.
Not provided in the article.