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Journal ArticleDOI

Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis

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...

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Citations
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Journal ArticleDOI

Uremic retention solutes: the free and the bound.

TL;DR: Many in the nephrology community were surprised when the Hemodialysis (HEMO) Study supported the null hypothesis for each intervention, suggesting ceiling effects for both the dose of dialysis and membrane permeability.
Journal ArticleDOI

Reporting of "dialysis adequacy" as an outcome in randomised trials conducted in adults on haemodialysis.

TL;DR: Being alive, time spent while being on dialysis, fatigue and friendliness of staff were the most prominent themes that patients linked to the construct of dialysis adequacy.
Journal ArticleDOI

Reduced cytokine induction and removal of complement products with synthetic hemodialysis membranes.

TL;DR: Cytokine induction on the blood side is further reduced by the use of high-flux membranes due to removal of activated complement factors, and certain synthetic membranes do not permit transfer of LPS.
Journal ArticleDOI

A national study of autogenous arteriovenous access use and patency in a contemporary hemodialysis population.

TL;DR: Despite advances in recent years with preoperative vessel assessment and surveillance, patency rates have not improved, with primary failure remaining the major obstacle.
References
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Book ChapterDOI

Nonparametric Estimation from Incomplete Observations

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

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.

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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