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
Reimbursement of Dialysis: A Comparison of Seven Countries
Raymond Vanholder,Andrew Davenport,Thierry Hannedouche,Jeroen P. Kooman,Andreas Kribben,Norbert Lameire,Gerhard Lonnemann,Peter Magner,David C. Mendelssohn,Subodh J. Saggi,Rachel Shaffer,Sharon M. Moe,Wim Van Biesen,Frank M. van der Sande,Rajnish Mehrotra +14 more
TL;DR: Important differences between countries exist, resulting in as much as a 3.3-fold difference between highest and lowest reimbursement rates for chronic hemodialysis, and it is not yet clear that such differences save money or improve quality of care.
Journal ArticleDOI
Predicting Mortality in Incident Dialysis Patients: An Analysis of the United Kingdom Renal Registry
Martin Wagner,David Ansell,David M. Kent,John L. Griffith,David Naimark,Christoph Wanner,Navdeep Tangri +6 more
TL;DR: Basic patient characteristics, comorbid conditions, and laboratory variables can predict 3-year mortality in incident dialysis patients with sufficient accuracy and Identification of subgroups of patients according to mortality risk can guide future research and subsequently target treatment decisions in individual patients.
Journal ArticleDOI
Serum β2-microglobulin level is a significant predictor of mortality in maintenance haemodialysis patients
Senji Okuno,Eiji Ishimura,Kaori Kohno,Yoko Fujino-Katoh,Yoshifumi Maeno,Tomoyuki Yamakawa,Masaaki Inaba,Yoshiki Nishizawa +7 more
TL;DR: The results demonstrate that the serum beta(2)-M level is a significant predictor of mortality in haemodialysis patients, independent of haemmodialysis duration, diabetes, malnutrition and chronic inflammation, suggesting the clinical importance of lowering serum beta-2-M in these patients.
Journal ArticleDOI
Self-reported appetite, hospitalization and death in haemodialysis patients: findings from the Hemodialysis (HEMO) Study
Jerrilynn D. Burrowes,Brett Larive,Glenn M. Chertow,David B. Cockram,Johanna T. Dwyer,Tom Greene,John W. Kusek,June Leung,Michael V. Rocco +8 more
TL;DR: Self-reported appetite was associated with hospitalization rate in haemodialysis patients and, thus, it may be a useful screening tool for this outcome, and patients who report poor or very poor appetites should be monitored.
Journal ArticleDOI
The Kidney and Uremic Toxin Removal: Glomerulus or Tubule?
Rosalinde Masereeuw,Henricus A. M. Mutsaers,Takafumi Toyohara,Takaaki Abe,Sachin R. Jhawar,Douglas H. Sweet,Jerome Lowenstein +6 more
TL;DR: The renal tubular clearance mechanisms for uremic toxins, as well as the intracellular events associated with their accumulation, are described, involving activation of the aryl hydrocarbon receptor, disturbance of mitochondrial functioning, and competition with metabolizing enzymes.
References
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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).
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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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