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 < or = 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 < or = 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 < or = 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 < or = 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.

Effect of membrane permeability on survival of hemodialysis patients.

STEFONI, SERGIO;CIANCIOLO, GIUSEPPE;BARALDI, OLGA;
2009

Abstract

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 < or = 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 < or = 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 < or = 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 < or = 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.
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Locatelli F; Martin-Malo A; Hannedouche T; Loureiro A; Papadimitriou M; Wizemann V; Jacobson SH; Czekalski S; Ronco C; Vanholder R; La Milia V; Pozzi M; Di Filippo S; La Greca G; Brendolan A; Crepaldi C; Stefoni S; Cianciolo G; Baraldi O; Maschio G; Loschiavo C; Barbieri C; Milanesi F; Redaelli B; Stella A; Viganò MR; Stellato T; Villa G; Segagli S; Montagna G; Quarello F; Vallero A; Forneris G; Borghi M; Tagliaferri M; Palmerio G; Imbasciati E; Farina M; Bucci R; Stallone C; Aucella F; Bellazzi C; De Vincenti A; Giannattasio M; Detomaso F; Malberti F; Pecchini P; Fabris A; Zanella M; Feriani M; Genchi R; Fraticelli M; D'Amico M; Bernardi LE; Palumbo R; De Cicco C; Pietrzak I; Drobnik M; Weyde W; Krajewska M; Penar J; Aljama P; Martín Malo A; Berdud I; Alvarez de Lara MA; Navas A; Martín García J; Chacón JC; Junco E; López Gómez JM; Villaverde M; Bustamante J; Martín García D; Sánchez L; Montenegro J; Ocharan J; Barril G; Besada E; Pastor JM; Gallar P; Almaraz M; Alcalá M; Silgado G; Gruss E; Portolés JM; Delgado R; Bittar H; Nony A; Chanard J; Randoux C; Maheut H; Dimitrov Y; Bouiller M; Simon P; Kim SA; Cremault A; Ryckelynck JP; Levaltier B; Jonon B; Saidani F; Maurice F; Kessler M; Hachicha M; Reach I; Bataille P; Nour D; Paiva A; Cruz J; Carvalho D; Buinho F; Santos JP; Sotto K; Sousa S; da Cruz L; Henriques C; Santos J; Vinhas J; Assunçao J; Memmos D; Belechri AM; Giamalis P; Dhondt A; Veys N; Van Biesen W; Verbeelen D; Krzesinski JM; Tielemans C; Lins R; Larsson K; Kurkus J; Weiss L; Welander G; Seidel S; Lotz C; Gruber H; Weinreich T; Rawer P; Bommer J; Hoenich NA; Leunissen KL.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/75867
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