Comparison of cellulose diacetate and polysulfone membranes in the outcome of acute renal failure. A prospective randomized study.
BACKGROUND
Whether the nature of haemodialysis (HD) membranes can influence the outcome of acute renal failure (ARF) remains debatable. Recent studies have suggested that dialysis with bioincompatible unsubstituted cellulosic membranes is associated with a less favourable patient outcome than dialysis with biocompatible synthetic membranes. Since we generally use a modified cellulosic membrane with substantially lower complement- and leukocyte-activating potential than cuprophane, for dialysis of patients with ARF, and because there are no data in the literature regarding the influence of modified cellulosic membranes on the outcome of patients with ARF, we compared the outcome of ARF patients dialysed either with cellulose diacetate or with a synthetic polysulfone membrane. We also investigated the potential role of permeability by comparing membranes with high-flux versus low-flux characteristics.


METHODS
This prospective, randomized, single centre study included 159 patients with ARF requiring HD. Patients were stratified according to age, gender, and APACHE II score and then randomized in chronological order to one of three dialysis membranes: low-flux polysulfone, high-flux polysulfone and meltspun cellulose diacetate.


RESULTS
Aetiologies of ARF and the prevalence of oliguria were similarly distributed among the three groups. There was no significant difference between the three groups for survival (multivariate Cox's proportional hazards model, P=0.57), time necessary to recover renal function (P=0.82), and number of dialysis sessions required before recovery (P=0.86). Multivariate analysis showed that survival was significantly influenced only by the severity of the disease state (APACHE III score, P<0.0001), but not by the nature of the dialysis membrane (P=0.57) or the presence of oliguria (P=0.24).


CONCLUSIONS
Among patients with ARF requiring HD survival and recovery time are not significantly influenced by the use of either meltspun cellulose diacetate or the more biocompatible high-flux or low-flux polysulfone. Dialysis using modified cellulose membranes is just as effective as dialysis using synthetic polysulfone membranes, but at a lower cost. In addition, the flux of the membrane did not influence patient outcome.
Gastaldello
K
K
Department of Nephrology, Dialysis and Transplantation and Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Melot
C
C
Kahn
R J
RJ
Vanherweghem
J L
JL
Vincent
J L
JL
Tielemans
C
C
D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D001672:Biocompatible Materials; D002482:Cellulose / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011108:Polymers; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012720:Severity of Illness Index; D013450:Sulfones; D016019:Survival Analysis
D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700; D002482:Cellulose; C026170:cellulose diacetate