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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^**, Stanislaw Czekalski, Claudio Ronco, Raymond Vanholder for the Membrane Permeability Outcome (MPO) Study Group

^* Department of Nephrology, Dialysis and Renal Transplantation, A. Manzoni Hospital, Lecco, Italy; Department of Nephrology, University Hospital Reina Sofia, Cordoba, Spain; Department of Nephrology, University Hospital, Strasbourg, France; Department of Nephrology, Portuguese Institute of Oncology, Porto, Portugal; ^|| Department of Nephrology, Hippokration General Hospital, Thessaloniki Greece; ^¶ Georg-Haas-Dialysis Centre, Giessen, Germany; ^** Department of Nephrology, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden; Department of Nephrology, Transplantology and Internal Diseases, Pozna University of Medical Sciences, Pozna, Poland; Department of Nephrology and Intensive Care, St. Bortolo Hospital, Vincenza, Italy; and Department of Internal Medicine, Nephrology Section, University Hospital, Ghent, Belgium

Correspondence: Prof. Francesco Locatelli, Department of Nephrology, Dialysis and Renal Transplantation, A. Manzoni Hospital, Via dell'Eremo 9/11, I-23900 Lecco, Italy. Phone: +39-0341-489850; Fax: +39-0341-489860; E-mail: f.locatelli{at}ospedale.lecco.it

Received for publication June 10, 2008. Accepted for publication September 22, 2008.

The effect of high-flux hemodialysis membranes on patient survival has not been unequivocally determined. In this prospective, randomized clinical trial, we enrolled 738 incident hemodialysis patients, stratified them by serum albumin 4 and >4 g/dl, and assigned them to either low-flux or high-flux membranes. We followed patients for 3 to 7.5 yr. Kaplan-Meier survival analysis showed no significant difference between high-flux and low-flux membranes, and a Cox proportional hazards model concurred. Patients with serum albumin 4 g/dl had significantly higher survival rates in the high-flux group compared with the low-flux group (P = 0.032). In addition, a secondary analysis revealed that high-flux membranes may significantly improve survival of patients with diabetes. Among those with serum albumin 4 g/dl, slightly different effects among patients with and without diabetes suggested a potential interaction between diabetes status and low serum albumin in the reduction of risk conferred by high-flux membranes. In summary, we did not detect a significant survival benefit with either high-flux or low-flux membranes in the population overall, but the use of high-flux membranes conferred a significant survival benefit among patients with serum albumin 4 g/dl. The apparent survival benefit among patients who have diabetes and are treated with high-flux membranes requires confirmation given the post hoc nature of our analysis.

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