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	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Himmelfarb, J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The effects of the dose of dialysis and the level of flux of the dialyzer membrane on mortality and morbidity among patients undergoing maintenance hemodialysis are uncertain.

Methods We undertook a randomized clinical trial in 1846 patients undergoing thrice-weekly dialysis, using a two-by-two factorial design to assign patients randomly to a standard or high dose of dialysis and to a low-flux or high-flux dialyzer.

Results In the standard-dose group, the mean (±SD) urea-reduction ratio was 66.3±2.5 percent, the single-pool Kt/V was 1.32±0.09, and the equilibrated Kt/V was 1.16±0.08; in the high-dose group, the values were 75.2±2.5 percent, 1.71±0.11, and 1.53±0.09, respectively. Flux, estimated on the basis of beta₂-microglobulin clearance, was 3±7 ml per minute in the low-flux group and 34±11 ml per minute in the high-flux group. The primary outcome, death from any cause, was not significantly influenced by the dose or flux assignment: the relative risk of death in the high-dose group as compared with the standard-dose group was 0.96 (95 percent confidence interval, 0.84 to 1.10; P=0.53), and the relative risk of death in the high-flux group as compared with the low-flux group was 0.92 (95 percent confidence interval, 0.81 to 1.05; P=0.23). The main secondary outcomes (first hospitalization for cardiac causes or death from any cause, first hospitalization for infection or death from any cause, first 15 percent decrease in the serum albumin level or death from any cause, and all hospitalizations not related to vascular access) also did not differ significantly between either the dose groups or the flux groups. Possible benefits of the dose or flux interventions were suggested in two of seven prespecified subgroups of patients.

Conclusions Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.

Source Information

From the Baylor College of Medicine, Houston (G.E.); the Cleveland Clinic Foundation, Cleveland (G.J.B., T.G.); the University of Utah and the Veterans Affairs Salt Lake City Health Care System, Salt Lake City (A.K.C.); the University of Illinois and the Veterans Affairs Chicago Health Care System, Chicago (J.T. Daugirdas); the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md. (J.W.K.); the University of Alabama at Birmingham, Birmingham (M.A.); Emory University Hospital, Atlanta (J.B.); Washington University, St. Louis (J.A.D.); the University of California at Davis, Sacramento (T.A.D.); New England Medical Center, Boston (J.T. Dwyer, A.S.L.); Beth Israel Medical Center, New York (N.W.L.); Brigham and Women's Hospital, Boston (E.M.); the University of Rochester, Rochester, N.Y. (D.B.O.); Wake Forest University, Winston-Salem, N.C. (M.V.R.); Vanderbilt University, Nashville (G.S.); Duke University, Durham, N.C. (S.J.S.); Lankenau Hospital and Medical Research Center, Wynnewood, Pa. (B.P.T.); and the University of Texas Southwestern Medical Center, Dallas (R.T.).

Address reprint requests to Dr. Beck at the HEMO Study Data Coordinating Center, Dept. of Biostatistics and Epidemiology, Wb4, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, or at beckg{at}ccf.org.

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Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Scribner B. H., Blagg C. R., Friedman E. A., Hoenich N. A., Locatelli F., Greene T., Cheung A. K., Eknoyan G., the Hemodialysis (HEMO) Study Group , Himmelfarb J.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:1491-1494, Apr 10, 2003. Correspondence

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