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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Book ChapterDOI
Nutritional Management of Maintenance Hemodialysis Patients
TL;DR: It is suggested that a gain in post-hemodialysis dry weight over time is associated with greater survival whereas unintentional weight loss harbors increased mortality risk over time, and increasing nutritional intake will reduce mortality risk.
Book ChapterDOI
Solute transport mechanisms in dialysis
Thomas Depner,Laurie Garred +1 more
TL;DR: Reabsorption across native kidney tubules is much more solute-specific than the relatively nonselective diffusion and convection across inert membranes of artificial kidneys, and the reabsorptive process works in reverse, conserving desirable solutes instead of removing unwanted solutes.
Journal ArticleDOI
Can the diverse family of dialysis adequacy indices be understood as one integrated system
TL;DR: The diverse family of dialysis adequacy indices can be understood as one integrated system and be useful when assessing both standard treatment modalities and newer schedules and modalities of renal replacement therapies.
Journal ArticleDOI
Slipping Through the Pores: Hypoalbuminemia and Albumin Loss During Hemodialysis.
Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,Linda H. Ficociello,Jennifer Bazzanella,Claudy Mullon,Michael S. Anger +6 more
TL;DR: In this article, the impact of dialyzer selection on albumin losses during conventional hemodialysis, including the clinical relevance of such losses on serum albumin levels, is examined.
Journal ArticleDOI
Is it time to revisit residual renal function in haemodialysis
TL;DR: The long held belief that peritoneal dialysis is better at preserving RRF than HD may no longer be true and more robust studies are required to determine the relative importance of RRF in HD and strategies to best preserve this vital asset.
References
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Book ChapterDOI
Nonparametric Estimation from Incomplete Observations
Edward L. Kaplan,Paul Meier +1 more
TL;DR: In this article, the product-limit (PL) estimator was proposed to estimate the proportion of items in the population whose lifetimes would exceed t (in the absence of such losses), without making any assumption about the form of the function P(t).
Book ChapterDOI
Regression Models and Life-Tables
TL;DR: The analysis of censored failure times is considered in this paper, where the hazard function is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time.
Book
Generalized Linear Models
Peter McCullagh,John A. Nelder +1 more
TL;DR: In this paper, a generalization of the analysis of variance is given for these models using log- likelihoods, illustrated by examples relating to four distributions; the Normal, Binomial (probit analysis, etc.), Poisson (contingency tables), and gamma (variance components).
Journal ArticleDOI
Generalized linear models. 2nd ed.
Peter McCullagh,John A. Nelder +1 more
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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