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J Am Soc Nephrol. 2009 Mar;20(3):645-54. doi: 10.1681/ASN.2008060590. Epub 2008 Dec 17.

Effect of membrane permeability on survival of hemodialysis patients.

Collaborators (139)

Locatelli F, La Milia V, Pozzi M, Di Filippo S, La Greca G, Ronco C, Brendolan A, Crepaldi C, Stefoni S, Ciancialo 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, Czekalski S, 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, Hannedouche T, 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, Loureiro A, 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, Papadimitriou M, Memmos D, Belechri AM, Giamalis P, Vanholder R, Dhondt A, Veys N, Van Biesen W, Verbeelen D, Krzesinski JM, Tielemans C, Lins R, Jacobson SH, Larsson K, Kurkus J, Weiss L, Welander G, Wizemann V, Seidel S, Lotz C, Gruber H, Weinreich T, Rawer P, Bommer J, Hoenich NA, Leunissen KL.

Author information

1
Department of Nephrology, Dialysis and Renal Transplantation, A Manzoni Hospital, Lecco, Italy. f.locatelli@ospedale.lecco.it

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.

PMID:
19092122
PMCID:
PMC2653681
DOI:
10.1681/ASN.2008060590
[Indexed for MEDLINE]
Free PMC Article

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