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
New insights into uremic toxicity.
TL;DR: The concept of uremia has expanded to encompass the illness patients begin to suffer as glomerular filtration rate declines long before the onset of end-stage renal disease (ESRD) not explained by known derangements in volume status or metabolic parameters, and p-Cresol sulfate and indoxyl sulfate have been linked to cardiovascular disease and oxidative injury.
Journal ArticleDOI
The effect of on-line high-flux hemofiltration versus low-flux hemodialysis on mortality in chronic kidney failure: a small randomized controlled trial.
Antonio Santoro,Elena Mancini,Roberto Bolzani,Rolando Boggi,Leonardo Cagnoli,Angelo Francioso,Maurizio Fusaroli,Valter Piazza,Renato Rapanà,Giovanni F.M. Strippoli +9 more
TL;DR: On-line HF may improve survival independent of Kt/V in patients with ESRD, with a significant decrease in plasma beta(2)-microglobulin levels and increased body mass index.
Journal ArticleDOI
Association of Achieved Dialysis Dose with Mortality in the Hemodialysis Study: An Example of “Dose-Targeting Bias”
Tom Greene,John T. Daugirdas,Thomas A. Depner,Michael Allon,Gerald J. Beck,Cameron Chumlea,James A. Delmez,Frank A. Gotch,John W. Kusek,Nathan W. Levin,William F. Owen,Gerald Schulman,Robert A. Star,Robert D. Toto,Garabed Eknoyan +14 more
TL;DR: Patients with the lowest achieved dose relative to their target dose experience markedly increased mortality, to a degree that is not compatible with a biologic effect of dose, when dialysis dose is targeted closely.
Journal ArticleDOI
Shorter length dialysis sessions are associated with increased mortality, independent of body weight
Jennifer E. Flythe,Jennifer E. Flythe,Gary C. Curhan,Gary C. Curhan,Steven M. Brunelli,Steven M. Brunelli +5 more
TL;DR: Among patients with adequate urea clearance, shorter dialysis session lengths are associated with increased mortality independent of body weight, and this association was consistent across strata of age, gender, and dialysis post-weight.
Journal ArticleDOI
The Initiating Dialysis Early and Late (IDEAL) study: study rationale and design
Bruce A. Cooper,Bruce A. Cooper,Pauline Branley,Liliana Bulfone,John F. Collins,Jonathan C. Craig,Jenny Dempster,Margaret B. Fraenkel,Anthony Harris,David Harris,David W. Johnson,Joan Kesselhut,Grant Luxton,Andrew Pilmore,Carol A. Pollock,David J. Tiller +15 more
TL;DR: The IDEAL study will provide evidence for the optimal time to commence dialysis and determine the impact of “early start’ versus “late start” dialysis on nutritional and cardiac morbidity, quality of life, and economic cost.
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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