Journal ArticleDOI
Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Garabed Eknoyan,Gerald J. Beck,Alfred K. Cheung,John T. Daugirdas,Tom Greene,John W. Kusek,Michael Allon,James L. Bailey,James A. Delmez,Thomas A. Depner,Johanna T. Dwyer,Andrew S. Levey,Nathan W. Levin,Edgar L. Milford,Daniel B. Ornt,Michael V. Rocco,Gerald Schulman,Steve J. Schwab,Brendan P. Teehan,Robert D. Toto +19 more
TLDR
Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.Abstract:
Background The effects of the dose of dialysis and the level of flux of the dialyzer membrane on mortality and morbidity among patients undergoing maintenance hemodialysis are uncertain. Methods We undertook a randomized clinical trial in 1846 patients undergoing thrice-weekly dialysis, using a two-by-two factorial design to assign patients randomly to a standard or high dose of dialysis and to a low-flux or high-flux dialyzer. Results In the standard-dose group, the mean (±SD) urea-reduction ratio was 66.3±2.5 percent, the single-pool Kt/V was 1.32±0.09, and the equilibrated Kt/V was 1.16±0.08; in the high-dose group, the values were 75.2±2.5 percent, 1.71±0.11, and 1.53±0.09, respectively. Flux, estimated on the basis of beta2-microglobulin clearance, was 3±7 ml per minute in the low-flux group and 34±11 ml per minute in the high-flux group. The primary outcome, death from any cause, was not significantly influenced by the dose or flux assignment: the relative risk of death in the high-dose group as com...read more
Citations
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Journal ArticleDOI
Confounding Effect of Comorbidities and Malnutrition on Survival of Peritoneal Dialysis Patients
Narayan Prasad,Amit Gupta,Archana Sinha,Raj Kumar Sharma,Anita Saxena,Anupama Kaul,Dharmender Bhaduria,Anurag Gupta +7 more
TL;DR: The confounding impact of comorbidities and malnutrition, alone or together, constitute independent predictors of survival in patients on continuous ambulatory peritoneal dialysis and patients with comor bidities are at high risk of developing malnutrition.
Journal ArticleDOI
Narrative Review of Incremental Hemodialysis.
TL;DR: A stepped dialysis regimen with scheduled transition from time-delineated twice-weeklyHD to thrice-weekly HD could represent an effective and safe strategy to standardize incremental HD in patients with CKD transitioning to early-stage ESKD.
Journal ArticleDOI
Elimination of middle-sized uremic solutes with high-flux and high-cut-off membranes: a randomized in vivo study.
TL;DR: HCO membranes are a promising approach to improve removal of uremic toxins not affected by conventional high-flux membranes.
Journal ArticleDOI
The effects of racial differences on body composition and total body water measured by multifrequency bioelectrical impedance analysis influence delivered Kt/V dialysis dosing.
TL;DR: Variation in body composition between ethnic groups potentially leads to over-estimation of delivered dose for some ethnic groups and underestimation for others when using anthropometric equations.
Journal ArticleDOI
Negative trials in nephrology: what can we learn?
TL;DR: General principles of trial design will be discussed and the potential lessons learned from recent trials in nephrology will be critically reviewed.
References
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Nonparametric Estimation from Incomplete Observations
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TL;DR: A class of statistical models that generalizes classical linear models-extending them to include many other models useful in statistical analysis, of particular interest for statisticians in medicine, biology, agriculture, social science, and engineering.
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