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Titolo Effect of Membrane Permeability on Survival of Hemodialysis Patients
Autore Francesco Locatelli,* Alejandro Martin-Malo,† Thierry Hannedouche,± Alfredo Loureiro,§ Menelaos Papadimitriou,_ Volker Wizemann, Stefan H. Jacobson,** Stanislaw Czekalski,†† Claudio Ronco,±± and Raymond Vanholder,§§ for the Membrane Permeability Outcome (MPO) Study Group - *Department of Nephrology, Dialysis and Renal Transplantation, A. Manzoni Hospital, Lecco, Italy; †Department of Nephrology, University Hospital Reina Sofia, Cordoba, Spain; ±Department of Nephrology, University Hospital, Strasbourg, France; §Department of Nephrology, Portuguese Institute of Oncology, Porto, Portugal; _Department of Nephrology, Hippokration General Hospital, Thessaloniki Greece; Georg-Haas-Dialysis Centre, Giessen, Germany; **Department of Nephrology, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden; ††Department of Nephrology, Transplantology and Internal Diseases, Poznan´ University of Medical Sciences, Poznan´ , Poland; ±±Department of Nephrology and Intensive Care, St. Bortolo Hospital, Vincenza, Italy; and §§Department of Internal Medicine, Nephrology Section, University Hospital, Ghent, Belgium
Referenza J Am Soc Nephrol 2008; doi: 10.1681/ASN.2008060590 JASN
Contenuto 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 _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 _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 _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 _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.
Data 08.01.2009
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