Dialyzer membrane permeability and survival in hemodialysis patients.
BACKGROUND
We previously showed that nutritional protein concentrations were predictive of outcome, whereas variables reflecting body composition and dialysis dose were not, in a 30-month prospective follow-up of 1,610 hemodialysis patients. Information on dialysis membrane and erythropoietin use had to be evaluated in an additional follow-up.


METHODS
A subset of 650 patients from the initial cohort of 1,610 was analyzed for survival in a 2-year extension of follow-up. Detailed data were collected: demographics; cause of renal failure; time on dialysis therapy; type of membrane; erythropoietin treatment; body mass index (BMI); predialysis albumin, prealbumin, and bicarbonate levels; and outcome. Normalized protein catabolic rate (nPCR), dialysis adequacy, and lean body mass were computed from predialysis and postdialysis urea and creatinine values.


RESULTS
Patient characteristics were age of 61 +/- 16 years, 58% men, BMI of 22.7 +/- 4.4 kg/m2 , time on dialysis therapy of 102 +/- 73 months, and 8.8% had diabetes. Dialysis parameters were duration of 247 +/- 31 minutes, Kt/V of 1.4 +/- 0.3, and nPCR of 1.2 +/- 0.3 g/kg/d. Albumin level was 3.73 +/- 0.53 g/dL (37.3 +/- 5.3 g/L), and prealbumin level was 31 +/- 8 mg/dL. The survival rate was 78.7% after 2 years. Survival was influenced by age, presence of diabetes, use of high-flux membrane, and serum albumin level, but not other variables, including Kt/V and prealbumin level. Two-year variations in values for urea, creatinine, and weight were predictive of survival in univariate, but not multivariate, analyses.


CONCLUSIONS
In patients on dialysis therapy for a long period, better survival was observed when high-flux dialysis membranes were used.
Chauveau
Philippe
P
Département de Néphrologie, Centre Hospitalier Universitaire and Université Bordeaux 2, Bordeaux, France. ph.chauveau@wanadoo.fr
Nguyen
Hiep
H
Combe
Christian
C
Chêne
Geneviève
G
Azar
Raymond
R
Cano
Noël
N
Canaud
Bernard
B
Fouque
Denis
D
Laville
Maurice
M
Leverve
Xavier
X
Roth
Hubert
H
Aparicio
Michel
M
D000368:Aged; D001639:Bicarbonates / Q000097:blood; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000401:mortality / Q000628:therapy; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015993:Life Tables; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D010539:Permeability; D011228:Prealbumin / Q000032:analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000401:mortality*; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis; D013997:Time Factors; D014508:Urea / Q000097:blood
D001639:Bicarbonates; D008567:Membranes, Artificial; D011228:Prealbumin; D012709:Serum Albumin; D004921:Erythropoietin; D014508:Urea; D002784:Cholesterol; D003404:Creatinine