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
Does provision of a higher Kt/Vurea make a difference? A hemodialysis controversial issue
TL;DR: This study used the neurophysiologic studies as a marker of the biologic status of the hemodialysis patients to assess the optimum level of Kt/Vurea.
Journal ArticleDOI
Nocturnal intermittent hemodialysis.
Julia Thumfart,Dominik N. Müller +1 more
TL;DR: Nocturnal intermittent dialysis programs provide a reasonable compromise of all forms of intensified programs for psychosocial rehabilitation and quality of life, and are described in this review.
Journal ArticleDOI
Do statins protect the kidney as well as the heart
TL;DR: The main results of this trial have been previously reported and the current article focuses on the 392 subjects who did not receive fosinopril, among whom the rate of change in albumin excretion and eGFR were similar in pravastatin and placebo recipients.
Journal ArticleDOI
La dose de dialyse en réanimation : existe-t-il vraiment un idéal ?
TL;DR: Dans ces temps de controverse, il nous semble important de ne pas conclure trop rapidement suite aux dernieres etudes negatives sur l’impact of the dose d’EER, yn ôl un nouvel outil de mesure non invasif de la dose de dialyse devrait etre evaluee.
Journal ArticleDOI
Musings on guidelines and evidence: a pragmatic and nephrocentric view.
TL;DR: The position is advanced that the idea of professional nephrology societies taking similar positions about applying evidence in guideline development is deeply flawed and should be scrapped.
References
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