"Morbidity Effects of Hemodialysis Dose and Membrane Flux". The New England Journal of Medicine. 1981. 305(20):1176-1181.

Clinical Question

Does the prescription of hemodialysis treatment regarding dialysis dose (as indicated by blood urea nitrogen levels) and duration affect patient morbidity?

Bottom Line

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.

Major Points

Guidelines

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.

Design

- 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

Population

- 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

Interventions

- 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.

Outcomes

- Primary Outcomes: Major organ-system index_gptes, psychosocial data, and general morbidity measures, including death, hospitalizations, and study withdrawal
- Secondary Outcomes: Not specified

Criticisms

- 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.

Funding

Supported under a contract (NO-l-AM-6–2207) from the National Institute of Arthritis, Metabolism, and Digestive Diseases.

Further Reading

Not provided in the article.