Dialyzer membrane characteristics and outcome of patients with type 2 diabetes on maintenance hemodialysis.
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.
Krane
Vera
V
University of Würzburg, Department of Medicine, Division of Nephrology, University Hospital Würzburg. krane_v@medizin.uni-wuerzburg.de
Krieter
Detlef H
DH
Olschewski
Manfred
M
März
Winfried
W
Mann
Johannes F E
JF
Ritz
Eberhard
E
Wanner
Christoph
C
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
D008567:Membranes, Artificial