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
Dialysis and Patient Factors Which Determine Convective Volume Exchange in Patients Treated by Postdilution Online Hemodiafiltration.
TL;DR: The convective exchange volumes during the midweek OL-HDF session in a cohort of 653 patients with corresponding bio-impedance measurements of volume status and sessional electronic records were audited and the convective volume exchanged was associated with sessional time and blood and dialysate flows.
Journal ArticleDOI
The Incidence and Pathophysiology of the Obesity Paradox: Should Peritoneal Dialysis and Kidney Transplant Be Offered to Patients with Obesity and End-Stage Renal Disease?
TL;DR: The obesity paradox phenomenon in ESRD is a unique illustration of survival benefit in a population that has a high overall annual mortality and peritoneal dialysis should be encouraged for obese patients who have preserved residual renal function.
Journal ArticleDOI
Long-term serum proteomes are quite similar under high- and low-flux hemodialysis treatment
TL;DR: The entire predialytic serum proteomes had to be analyzed using identical hemodialysis membrane material but with different cut‐off values, to identify long‐term differences of middle and high‐molecular‐weight serum constituents under high‐ and low‐flux he modialysis treatments.
Journal ArticleDOI
Impact of residual kidney function on hemodialysis adequacy and patient survival.
Mengjing Wang,Mengjing Wang,Yoshitsugu Obi,Elani Streja,Elani Streja,Connie M. Rhee,Connie M. Rhee,Jing Chen,Chuanming Hao,Csaba P. Kovesdy,Csaba P. Kovesdy,Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh +13 more
TL;DR: Investigation hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher heModialysis doses, and rCLurea levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodIALysis patients.
Journal ArticleDOI
Dyslipidemia, inflammation and dialysis outcomes: what we know now
TL;DR: A complex pathogenetic process and a number of new emerging cardiovascular disease risk factors in the setting of high-grade inflammation/infection are proposed as being responsible for cardiac disease in diabetic hemodialysis patients.
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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