Randomized trial of high-flux vs low-flux haemodialysis: effects on homocysteine and lipids.
BACKGROUND
Uncontrolled studies have found that high-flux haemodialysis favourably modifies homocysteine and lipid profiles. We sought to confirm these findings by carrying out a randomized prospective comparison of high-flux and low-flux polysulphone in chronic, stable dialysis patients.


METHODS
Forty-eight patients were randomly assigned to either high or low-flux dialysis for 3 months. Serum levels of homocysteine, lipoprotein (a), and lipids were compared between the treatment groups at monthly intervals.


RESULTS
All patient characteristics and laboratory variables were equally distributed between the groups at baseline. Over the study duration, we observed no differences between high- and low-flux treatment groups for the following outcomes: pre-dialysis homocysteine, lipoprotein (a), total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides (all P>0.05). Geometric mean (interquartile range) homocysteine at baseline was 20.0 (16.8-24.5) and 19.5 (15.3-22.0) micromol/l for the high-and low-flux groups respectively (P=0.80), and levels did not change significantly during the study. We did demonstrate a more pronounced intradialytic effect of high-flux dialysis on homocysteine levels, which fell during dialysis by 42%, compared to 32% with low-flux dialysis (P<0. 001).


CONCLUSIONS
In this randomized controlled trial, the effects of high-flux and low-flux haemodialysis on homocysteine and lipid profiles were comparable. The greater intradialytic effect of high-flux dialysis on homocysteine did not translate into a significant difference in pre-dialysis levels after 3 months of study.
House
A A
AA
Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada.
Wells
G A
GA
Donnelly
J G
JG
Nadler
S P
SP
Hébert
P C
PC
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008055:Lipids / Q000097:blood*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011108:Polymers; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D013450:Sulfones
D001672:Biocompatible Materials; D008055:Lipids; D017270:Lipoprotein(a); D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; D006710:Homocysteine; C017662:polysulfone P 1700