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Clin J Am Soc Nephrol. 2010 Sep;5(9):1628-36. doi: 10.2215/CJN.02350310. Epub 2010 Jul 1.

Can rescaling dose of dialysis to body surface area in the HEMO study explain the different responses to dose in women versus men?

Author information

1
Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612-7323, USA. jtdaugir@uic.edu

Abstract

BACKGROUND AND OBJECTIVES:

In the Hemodialysis (HEMO) Study, the lower death rate in women but not in men assigned to the higher dose (Kt/V) could have resulted from use of "V" as the normalizing factor, since women have a lower anthropometric V per unit of surface area (V/SA) than men.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

The effect of Kt/V on mortality was re-examined after normalizing for surface area and expressing dose as surface area normalized standard Kt/V (SAn-stdKt/V).

RESULTS:

Both men and women in the high-dose group received approximately 16% more dialysis (when expressed as SAn-stdKt/V) than the controls. SAn-stdKt/V clustered into three levels: 2.14/wk for conventional dose women, 2.44/wk for conventional dose men or 2.46/wk for high-dose women, and 2.80/wk for high-dose men. V/SA was associated with the effect of dose assignment on the risk of death; above 20 L/m(2), the mortality hazard ratio = 1.23 (0.99 to 1.53); below 20 L/m(2), hazard ratio = 0.78 (0.65 to 0.95), P = 0.002. Within gender, V/SA did not modify the effect of dose on mortality.

CONCLUSIONS:

When normalized to body surface area rather than V, the dose of dialysis in women in the HEMO Study was substantially lower than in men. The lowest surface-area-normalized dose was received by women randomized to the conventional dose arm, possibly explaining the sex-specific response to dialysis dose. Results are consistent with the hypothesis that when dialysis dose is expressed as Kt/V, women, due to their lower V/SA ratio, require a higher amount than men.

PMID:
20595687
PMCID:
PMC2974404
DOI:
10.2215/CJN.02350310
[Indexed for MEDLINE]
Free PMC Article

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