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
Effect of Membrane Permeability on Survival of Hemodialysis Patients
Francesco Locatelli,Alejandro Martin-Malo,Thierry Hannedouche,Alfredo Loureiro,Menelaos Papadimitriou,Volker Wizemann,Stefan H. Jacobson,Stanisław Czekalski,Claudio Ronco,Raymond Vanholder +9 more
TL;DR: The use of high-flux membranes conferred a significant survival benefit among patients with serum albumin < or = 4 g/dl, but the apparent survival Benefit among patients who have diabetes and are treated with high- flux membranes requires confirmation given the post hoc nature of the analysis.
Journal ArticleDOI
Free serum concentrations of the protein-bound retention solute p-cresol predict mortality in hemodialysis patients
TL;DR: The data suggest that free serum levels of p-cresol, a representative of the protein-bound uremic retention solutes, are associated with mortality in HD patients, and may encourage nephrologists to widen their field of interest beyond the scope of small water-soluble ureming solutes and middle molecules.
Journal ArticleDOI
Confounding: What it is and how to deal with it
TL;DR: This paper explains that to be a potential confounder, a variable needs to satisfy all three of the following criteria: it must have an association with the disease, that is, it should be a risk factor for the disease; it must be associated with the exposure, and it Must be unequally distributed between exposure groups.
Journal ArticleDOI
Left Ventricular Mass in Chronic Kidney Disease and ESRD
TL;DR: A new paradigm of therapy for CKD and ESRD that places prevention and reversal of LVH and cardiac fibrosis as a high priority is needed, which will require novel approaches to management and controlled interventional trials to provide evidence to fuel the transition from old to new treatment strategies.
Journal ArticleDOI
Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients: An analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2
Fabian Termorshuizen,Friedo W. Dekker,Jeannette G. van Manen,Johanna C. Korevaar,Elisabeth W. Boeschoten,Raymond T. Krediet +5 more
TL;DR: Residual renal clearance seems to be an important predictor of survival in HD patients, and the dKt/V(urea) should be tuned appropriately to the presence of renal function.
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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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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