title: The MPO Study: just a European HEMO Study or something very different?
abstract: Although results from observational and epidemiological studies suggested a survival benefit associated with high-flux hemodialysis, conclusive evidence from prospective randomized clinical trials has been lacking. Both the HEMO Study in the USA and the Membrane Permeability Outcome Study (MPO Study) in Europe are randomized studies investigating the effect of high- and low-flux hemodialysis on patient outcomes, even though there were some significant differences in the design of the two studies. An earlier randomized clinical trial could not show differences on patient survival between patient groups being treated with membranes of different material and permeability, but this trial was not designed specifically to examine this particular endpoint. Based on these previous experiences, the MPO Study addressed a hemodialysis patient population which was considered to be more susceptible to the intervention with high-flux dialysis. To identify these patients with an elevated risk, low serum albumin levels were chosen as an indicator; low serum albumin is associated with malnutrition, inflammation, atherosclerosis, and with increased risk of morbidity and mortality. Together with low serum albumin, patients had to be new to dialysis to be selected for the MPO Study. These particular considerations on patient selection, together with additional methodological refinements in the study design allow the conclusion that the MPO Study is valid on its own rather than being a European version of the HEMO Study.
authors.affiliation: Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy. f.locatelli@ospedale.lecco.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Adelheid
authors.initials: A
authors.lastname: Gauly
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Czekalski
authors.forename: Thierry
authors.initials: T
authors.lastname: Hannedouche
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.forename: Alfredo
authors.initials: A
authors.lastname: Loureiro
authors.forename: Alejandro
authors.initials: A
authors.lastname: Martin-Malo
authors.forename: Menelaos
authors.initials: M
authors.lastname: Papadimitriou
authors.forename: Jutta
authors.initials: J
authors.lastname: Passlick-Deetjen
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.forename: Volker
authors.initials: V
authors.lastname: Wizemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008567:Membranes, Artificial; D008875:Middle Aged; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D016019:Survival Analysis
chemical_list: D008567:Membranes, Artificial