title: Dialyzer membrane characteristics and outcome of patients with type 2 diabetes on maintenance hemodialysis.
abstract: BACKGROUND
  Effects of dialyzer membrane characteristics on morbidity and mortality are highly controversial.
  
  
  METHODS
  Post hoc, we analyzed data from the German Diabetes and Dialysis Study that evaluated atorvastatin in high-risk patients. Four groups were identified being constantly dialyzed with high-flux synthetic (n = 241), low-flux synthetic (n = 247), low-flux semisynthetic (n = 119), or cellulosic low-flux membranes (n = 41). Two end points were investigated: (1) a cardiovascular end point consisting of cardiac death, nonfatal myocardial infarction, and stroke and (2) death.
  
  
  RESULTS
  After 4 years of follow-up, adjusted multivariate relative risks (RRs) were calculated. The RR to reach a cardiovascular end point was greater for patients dialyzed with cellulosic low-flux (RR, 2.33; 95% confidence interval [CI], 1.38 to 3.94; P = 0.002), low-flux semisynthetic (RR, 1.92; 95% CI, 1.35 to 2.73; P = 0.0003), or low-flux synthetic membranes (RR, 1.35; 95% CI, 0.99 to 1.85; P = 0.06) than for those treated with high-flux synthetic dialyzers. The likelihood to die was greater with cellulosic low-flux (RR, 4.14; 95% CI, 2.79 to 6.15; P < 0.0001), low-flux semisynthetic (RR, 2.24; 95% CI, 1.66 to 3.02; P < 0.0001), and low-flux synthetic membranes (RR, 1.59; 95% CI, 1.22 to 2.07; P = 0.0006) than with high-flux synthetic membranes. With respect to low-flux synthetic membranes, RRs of mortality for patients using cellulosic low-flux and low-flux semisynthetic membranes were 161% (RR, 2.61; 95 % CI, 1.80 to 3.79; P < 0.0001) and 41% (RR, 1.41; 95% CI, 1.07 to 1.86; P = 0.016) greater. Cellulosic low-flux membrane use was associated with an 85% (RR, 1.85; 95% CI, 1.24 to 2.76; P = 0.0025) greater RR of death than low-flux semisynthetic membranes.
  
  
  CONCLUSIONS
  These data suggest that biocompatibility and permeability may impact on death and cardiovascular events in hemodialysis patients with type 2 diabetes mellitus.
authors.affiliation: University of Würzburg, Department of Medicine, Division of Nephrology, University Hospital Würzburg. krane_v@medizin.uni-wuerzburg.de
authors.forename: Vera
authors.initials: V
authors.lastname: Krane
authors.forename: Detlef H
authors.initials: DH
authors.lastname: Krieter
authors.forename: Manfred
authors.initials: M
authors.lastname: Olschewski
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Johannes F E
authors.initials: JF
authors.lastname: Mann
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D008567:Membranes, Artificial