Effect of membrane permeability on survival of hemodialysis patients
Francesco Locatelli, Alejandro Martin-Malo, Thierry Hannedouche, Alfredo Loureiro, Menelaos Papadimitriou, Volker Wizemann, Stefan H Jacobson, Stanislaw Czekalski, Claudio Ronco, Raymond Vanholder, Membrane Permeability Outcome (MPO) Study Group, F Locatelli, V La Milia, M Pozzi, S Di Filippo, G La Greca, C Ronco, A Brendolan, C Crepaldi, S Stefoni, G Ciancialo, O Baraldi, G Maschio, C Loschiavo, C Barbieri, F Milanesi, B Redaelli, A Stella, M R Viganò, T Stellato, G Villa, S Segagli, G Montagna, F Quarello, A Vallero, G Forneris, M Borghi, M Tagliaferri, G Palmerio, E Imbasciati, M Farina, R Bucci, C Stallone, F Aucella, C Bellazzi, A De Vincenti, M Giannattasio, F Detomaso, F Malberti, P Pecchini, A Fabris, M Zanella, M Feriani, R Genchi, M Fraticelli, M D'Amico, L E Bernardi, R Palumbo, C De Cicco, S Czekalski, I Pietrzak, M Drobnik, W Weyde, M Krajewska, J Penar, P Aljama, A Martín Malo, I Berdud, M A Alvarez de Lara, A Navas, J Martín García, J C Chacón, E Junco, J M López Gómez, M Villaverde, J Bustamante, D Martín García, L Sánchez, J Montenegro, J Ocharan, G Barril, E Besada, J M Pastor, P Gallar, M Almaraz, M Alcalá, G Silgado, E Gruss, J M Portolés, R Delgado, T Hannedouche, H Bittar, A Nony, J Chanard, C Randoux, H Maheut, Y Dimitrov, M Bouiller, P Simon, Seng Ang Kim, A Cremault, J-P Ryckelynck, B Levaltier, B Jonon, F Saidani, F Maurice, M Kessler, M Hachicha, I Reach, P Bataille, D Nour, A Loureiro, A Paiva, J Cruz, D Carvalho, F Buinho, J P Santos, K Sotto, S Sousa, L da Cruz, C Henriques, J Santos, J Vinhas, J Assunçao, M Papadimitriou, D Memmos, A M Belechri, P Giamalis, R Vanholder, A Dhondt, N Veys, W Van Biesen, D Verbeelen, J-M Krzesinski, C Tielemans, R Lins, S H Jacobson, K Larsson, J Kurkus, L Weiss, G Welander, V Wizemann, S Seidel, C Lotz, H Gruber, T Weinreich, P Rawer, J Bommer, N A Hoenich, K L M Leunissen, Francesco Locatelli, Alejandro Martin-Malo, Thierry Hannedouche, Alfredo Loureiro, Menelaos Papadimitriou, Volker Wizemann, Stefan H Jacobson, Stanislaw Czekalski, Claudio Ronco, Raymond Vanholder, Membrane Permeability Outcome (MPO) Study Group, F Locatelli, V La Milia, M Pozzi, S Di Filippo, G La Greca, C Ronco, A Brendolan, C Crepaldi, S Stefoni, G Ciancialo, O Baraldi, G Maschio, C Loschiavo, C Barbieri, F Milanesi, B Redaelli, A Stella, M R Viganò, T Stellato, G Villa, S Segagli, G Montagna, F Quarello, A Vallero, G Forneris, M Borghi, M Tagliaferri, G Palmerio, E Imbasciati, M Farina, R Bucci, C Stallone, F Aucella, C Bellazzi, A De Vincenti, M Giannattasio, F Detomaso, F Malberti, P Pecchini, A Fabris, M Zanella, M Feriani, R Genchi, M Fraticelli, M D'Amico, L E Bernardi, R Palumbo, C De Cicco, S Czekalski, I Pietrzak, M Drobnik, W Weyde, M Krajewska, J Penar, P Aljama, A Martín Malo, I Berdud, M A Alvarez de Lara, A Navas, J Martín García, J C Chacón, E Junco, J M López Gómez, M Villaverde, J Bustamante, D Martín García, L Sánchez, J Montenegro, J Ocharan, G Barril, E Besada, J M Pastor, P Gallar, M Almaraz, M Alcalá, G Silgado, E Gruss, J M Portolés, R Delgado, T Hannedouche, H Bittar, A Nony, J Chanard, C Randoux, H Maheut, Y Dimitrov, M Bouiller, P Simon, Seng Ang Kim, A Cremault, J-P Ryckelynck, B Levaltier, B Jonon, F Saidani, F Maurice, M Kessler, M Hachicha, I Reach, P Bataille, D Nour, A Loureiro, A Paiva, J Cruz, D Carvalho, F Buinho, J P Santos, K Sotto, S Sousa, L da Cruz, C Henriques, J Santos, J Vinhas, J Assunçao, M Papadimitriou, D Memmos, A M Belechri, P Giamalis, R Vanholder, A Dhondt, N Veys, W Van Biesen, D Verbeelen, J-M Krzesinski, C Tielemans, R Lins, S H Jacobson, K Larsson, J Kurkus, L Weiss, G Welander, V Wizemann, S Seidel, C Lotz, H Gruber, T Weinreich, P Rawer, J Bommer, N A Hoenich, K L M Leunissen
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.
Figures
Figure 2.
Kaplan-Meier survival curves for the…
Figure 2.
Kaplan-Meier survival curves for the complete intention-to-treat population (Log-rank test P = 0.214).
Figure 3.
Kaplan-Meier survival curves for the…
Figure 3.
Kaplan-Meier survival curves for the population of patients with serum albumin ≤4 g/dl…
Figure 4.
Kaplan-Meier survival curves for the…
Figure 4.
Kaplan-Meier survival curves for the subpopulation of patients with diabetes (Log-rank test P…
Source: PubMed