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
Treatment Policy rather than Patient Characteristics Determines Convection Volume in Online Post-Dilution Hemodiafiltration
I. Chapdelaine,Ira M. Mostovaya,P.J. Blankestijn,Michiel L. Bots,M.A. van den Dorpel,Renée Lévesque,Menso J. Nubé,P. M. Ter Wee,Muriel P.C. Grooteman +8 more
TL;DR: Treatment time and blood flow rate are major determinants of convection volume and its magnitude depends on center policy rather than individualized patient prescription.
Journal ArticleDOI
The TiME Trial: A Fully Embedded, Cluster-Randomized, Pragmatic Trial of Hemodialysis Session Duration
Laura M. Dember,Eduardo Lacson,Steven M. Brunelli,Jesse Y. Hsu,Alfred K. Cheung,John T. Daugirdas,Tom Greene,Csaba P. Kovesdy,Dana C. Miskulin,Ravi Thadhani,Ravi Thadhani,Wolfgang C. Winkelmayer,Susan S. Ellenberg,Denise Cifelli,Rosemary Madigan,Amy E. Young,Michael Angeletti,Rebecca L. Wingard,Christina Kahn,Allen R. Nissenson,Franklin W. Maddux,Kevin C. Abbott,J. Richard Landis +22 more
TL;DR: Although a highly pragmatic design allowed efficient enrollment, data acquisition, and monitoring, intervention uptake was insufficient to determine whether longer hemodialysis sessions improve outcomes, and more effective strategies are likely required to evaluate clinical trial interventions that are fully embedded in care delivery.
Journal ArticleDOI
Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients
Jeong-Hoon Lim,Yeongwoo Park,Ju-Min Yook,Soon-Youn Choi,Hee-Yeon Jung,Ji-Young Choi,Sun-Hee Park,Chan-Duck Kim,Yong-Lim Kim,Jang-Hee Cho +9 more
TL;DR: MCO dialyzers may improve patient-reported outcomes, particularly the physical components of QOL and uremic pruritus, in patients with high-flux dialyzer.
Journal ArticleDOI
β-Blockers for Prevention of Sudden Cardiac Death in Patients on Hemodialysis: A Propensity Score Analysis of the HEMO Study
Navdeep Tangri,Shani Shastri,Hocine Tighiouart,Gerald J. Beck,Alfred K. Cheung,Garabed Eknoyan,Mark J. Sarnak +6 more
TL;DR: In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death, however, there was a trend toward benefit in those with IHD.
Journal ArticleDOI
Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis
Mi Jung Lee,Jung Tak Park,Kyoung Sook Park,Young Eun Kwon,Hyung Jung Oh,Tae Hyun Yoo,Yong-Lim Kim,Yon Su Kim,Chul Woo Yang,Nam Ho Kim,Shin Wook Kang,Seung Hyeok Han +11 more
TL;DR: It is suggested that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine.
References
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Book ChapterDOI
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).
Book ChapterDOI
Regression Models and Life-Tables
TL;DR: The analysis of censored failure times is considered in this paper, where the hazard function is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time.
Book
Generalized Linear Models
Peter McCullagh,John A. Nelder +1 more
TL;DR: In this paper, a generalization of the analysis of variance is given for these models using log- likelihoods, illustrated by examples relating to four distributions; the Normal, Binomial (probit analysis, etc.), Poisson (contingency tables), and gamma (variance components).
Journal ArticleDOI
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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