title: Effect of membrane permeability on survival of hemodialysis patients.
abstract: The effect of high-flux hemodialysis membranes on patient survival has not been unequivocally determined. In this prospective, randomized clinical trial, we enrolled 738 incident hemodialysis patients, stratified them by serum albumin < or = 4 and >4 g/dl, and assigned them to either low-flux or high-flux membranes. We followed patients for 3 to 7.5 yr. Kaplan-Meier survival analysis showed no significant difference between high-flux and low-flux membranes, and a Cox proportional hazards model concurred. Patients with serum albumin < or = 4 g/dl had significantly higher survival rates in the high-flux group compared with the low-flux group (P = 0.032). In addition, a secondary analysis revealed that high-flux membranes may significantly improve survival of patients with diabetes. Among those with serum albumin < or = 4 g/dl, slightly different effects among patients with and without diabetes suggested a potential interaction between diabetes status and low serum albumin in the reduction of risk conferred by high-flux membranes. In summary, we did not detect a significant survival benefit with either high-flux or low-flux membranes in the population overall, but the use of high-flux membranes conferred a significant survival benefit among patients with serum albumin < or = 4 g/dl. The apparent survival benefit among patients who have diabetes and are treated with high-flux membranes requires confirmation given the post hoc nature of our analysis.
authors.affiliation: Department of Nephrology, Dialysis and Renal Transplantation, A Manzoni Hospital, Lecco, Italy. f.locatelli@ospedale.lecco.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Alejandro
authors.initials: A
authors.lastname: Martin-Malo
authors.forename: Thierry
authors.initials: T
authors.lastname: Hannedouche
authors.forename: Alfredo
authors.initials: A
authors.lastname: Loureiro
authors.forename: Menelaos
authors.initials: M
authors.lastname: Papadimitriou
authors.forename: Volker
authors.initials: V
authors.lastname: Wizemann
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Czekalski
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
mesh_terms: D000368:Aged; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000628:therapy; D007688:Kidneys, Artificial; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010539:Permeability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality*
chemical_list: D008567:Membranes, Artificial