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The impact of high-flux dialysis on mortality rates in incident and prevalent hemodialysis patients.

Kim HW, Kim SH, Kim YO, Jin DC, Song HC, Choi EJ, Kim YL, Kim YS, Kang SW, Kim NH, Yang CW, Kim YK - Korean J. Intern. Med. (2014)

Bottom Line: Following a median 24 months of follow-up, the mortality rates of the HF and low-flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878).In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009).HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

ABSTRACT

Background/aims: The effect of high-flux (HF) dialysis on mortality rates could vary with the duration of dialysis. We evaluated the effects of HF dialysis on mortality rates in incident and prevalent hemodialysis (HD) patients.

Methods: Incident and prevalent HD patients were selected from the Clinical Research Center registry for end-stage renal disease (ESRD), a Korean prospective observational cohort study. Incident HD patients were defined as newly diagnosed ESRD patients initiating HD. Prevalent HD patients were defined as patients who had been receiving HD for > 3 months. The primary outcome measure was all-cause mortality.

Results: This study included 1,165 incident and 1,641 prevalent HD patients. Following a median 24 months of follow-up, the mortality rates of the HF and low-flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878). In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009).

Conclusions: HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients.

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Related in: MedlinePlus

Kaplan-Meier survival curve for mortality rates associated with high-flux and low-flux membrane use in prevalent patients.
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Figure 2: Kaplan-Meier survival curve for mortality rates associated with high-flux and low-flux membrane use in prevalent patients.

Mentions: A total of 246 prevalent HD patients withdrew from the study for reasons other than death, comprising 71 patients who received kidney transplantations, 103 who transferred to a nonparticipating hospital, 38 who withdrew their participation during the treatment period, and 34 others who withdrew during the follow-up. One hundred and thirty-nine deaths occurred during the follow-up period. The leading causes of death were cardiovascular events (33.8% of all deaths) and infectious diseases (25.9% of all deaths). The absolute mortality rate during the follow-up period was 3.6 deaths per 100 person-years. In univariate Cox regression analysis, HF dialysis was associated with significantly reduced mortality rates (HR, 0.641; 95% CI, 0.454 to 0.906; p = 0.012). Fig. 2 depicts the Kaplan-Meier plot for all-cause mortality in prevalent HD patients according to HF or LF membrane use. Mortality was lower in the HF group compared with the LF group (p = 0.011; log-rank test). Even after adjusting for demographic variables, comorbid conditions and laboratory data, the adjusted HR for mortality was 0.606 (95% CI, 0.416 to 0.885; p = 0.009) in prevalent HD patients of the HF group: the HF group had a 39.4% lower risk of death compared with the LF group (Table 4).


The impact of high-flux dialysis on mortality rates in incident and prevalent hemodialysis patients.

Kim HW, Kim SH, Kim YO, Jin DC, Song HC, Choi EJ, Kim YL, Kim YS, Kang SW, Kim NH, Yang CW, Kim YK - Korean J. Intern. Med. (2014)

Kaplan-Meier survival curve for mortality rates associated with high-flux and low-flux membrane use in prevalent patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219967&req=5

Figure 2: Kaplan-Meier survival curve for mortality rates associated with high-flux and low-flux membrane use in prevalent patients.
Mentions: A total of 246 prevalent HD patients withdrew from the study for reasons other than death, comprising 71 patients who received kidney transplantations, 103 who transferred to a nonparticipating hospital, 38 who withdrew their participation during the treatment period, and 34 others who withdrew during the follow-up. One hundred and thirty-nine deaths occurred during the follow-up period. The leading causes of death were cardiovascular events (33.8% of all deaths) and infectious diseases (25.9% of all deaths). The absolute mortality rate during the follow-up period was 3.6 deaths per 100 person-years. In univariate Cox regression analysis, HF dialysis was associated with significantly reduced mortality rates (HR, 0.641; 95% CI, 0.454 to 0.906; p = 0.012). Fig. 2 depicts the Kaplan-Meier plot for all-cause mortality in prevalent HD patients according to HF or LF membrane use. Mortality was lower in the HF group compared with the LF group (p = 0.011; log-rank test). Even after adjusting for demographic variables, comorbid conditions and laboratory data, the adjusted HR for mortality was 0.606 (95% CI, 0.416 to 0.885; p = 0.009) in prevalent HD patients of the HF group: the HF group had a 39.4% lower risk of death compared with the LF group (Table 4).

Bottom Line: Following a median 24 months of follow-up, the mortality rates of the HF and low-flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878).In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009).HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

ABSTRACT

Background/aims: The effect of high-flux (HF) dialysis on mortality rates could vary with the duration of dialysis. We evaluated the effects of HF dialysis on mortality rates in incident and prevalent hemodialysis (HD) patients.

Methods: Incident and prevalent HD patients were selected from the Clinical Research Center registry for end-stage renal disease (ESRD), a Korean prospective observational cohort study. Incident HD patients were defined as newly diagnosed ESRD patients initiating HD. Prevalent HD patients were defined as patients who had been receiving HD for > 3 months. The primary outcome measure was all-cause mortality.

Results: This study included 1,165 incident and 1,641 prevalent HD patients. Following a median 24 months of follow-up, the mortality rates of the HF and low-flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878). In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009).

Conclusions: HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients.

Show MeSH
Related in: MedlinePlus