A randomized, controlled study of the consequences of hemodialysis membrane composition on erythropoietic response.
BACKGROUND
Membrane biocompatibility has long been thought to be relevant to hemodialysis outcomes and, possibly, renal anemia.


METHODS
We performed a randomized, controlled, single-center study comparing the consequences on renal anemia of 2 dialyzers of equivalent performance, but different composition, during 7 months. Two hundred eleven patients of an unselected dialysis population of 235 patients gave informed consent to undergo random assignment to either group A (SF170E; modified cellulose triacetate/midflux membrane; Nipro, Osaka, Japan) or group B (HF80LS; polysulfone/high-flux membrane; Fresenius, Bad Homburg, Germany). Anemia management was identical in both treatment groups and followed strict clinical protocols managed by computer algorithms. Dialysis adequacy, hemoglobin (Hb) level, ferritin level, percentage of red blood cell hypochromicity, C-reactive protein (CRP) level, and intravenous iron and epoetin doses were monitored monthly.


RESULTS
One hundred seventy-seven patients completed the 7-month study. Equilibrated Kt/V increased in both groups. Hb outcome improved overall, but did not differ between the 2 study groups. Epoetin dose was not significantly different after 7 months compared with baseline in either group. Hb level, epoetin dose, iron status, CRP level, dialysis Kt/V, and residual renal function did not differ between the 2 groups. A slight but significant negative correlation was identified between dialysis Kt/V and Hb level in the population as a whole (Spearman's correlation, -0.16; P = 0.04).


CONCLUSIONS
No significant epoetin-sparing effect was identified through the use of the high-flux polysulfone HF80LS membrane over the modified cellulose triacetate SF170E membrane. Although not a primary outcome for this study, there was a suggestion of benefit of improved Hb level, without increased need for epoetin, through increasing delivered dialysis dose.
Richardson
Donald
D
Department of Renal Medicine, St James's University Hospital, Leeds, UK. drichardson@doctors.org.uk
Lindley
Elizabeth J
EJ
Bartlett
Cherry
C
Will
Eric J
EJ
D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D002482:Cellulose / Q000031:analogs & derivatives* / Q000494:pharmacology*; D000068817:Epoetin Alfa; D004912:Erythrocytes / Q000187:drug effects; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011108:Polymers / Q000494:pharmacology*; D011188:Potassium / Q000097:blood; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D013450:Sulfones / Q000494:pharmacology*
D006454:Hemoglobins; D008567:Membranes, Artificial; D010281:Parathyroid Hormone; D011108:Polymers; D011994:Recombinant Proteins; D013450:Sulfones; D004921:Erythropoietin; C017662:polysulfone P 1700; D010758:Phosphorus; D000068817:Epoetin Alfa; D002482:Cellulose; D002097:C-Reactive Protein; D005293:Ferritins; C024671:cellulose triacetate; D007501:Iron; D011188:Potassium