Medium Cutoff Versus High-Flux Hemodialysis Membranes and Clinical Outcomes: A Cohort Study Using Inverse Probability Treatment WeightingPlain-Language Summary

Kidney Medicine

卷:4

Angela S. Rivera¹  Alejandra P. Molano²  Jasmín I. Vesga³  Mauricio Sanabria⁴  María P. Dazzarola⁵  Mauricio Guerrero⁶  Mario Munevar⁶  Ricardo Sanchez⁷  Giancarlo Buitrago⁷  Colin A. Hutchison⁸ 

[1] Baxter Healthcare Corporation, Deerfield, IL;

[2] Baxter Renal Care Services–Agencia Cardioinfantil, Bogotá, DC, Colombia;

[3] Baxter Renal Care Services–Colombia, Bucaramanga, Colombia;

[4] Baxter Renal Care Services–Latin America, Bogotá, DC, Colombia;

[5] Baxter Renal Care Services–Servicios de Terapia Renal del Valle, Cali, Colombia;

[6] Baxter Renal Care Services–Sucursal Barranquilla, Barranquilla, Colombia;

[7] Clinical Research Institute, School of Medicine, National University of Colombia, Bogotá, DC, Colombia;

[8] Department of Medicine, Hawke’s Bay District Health Board, Hastings, New Zealand;

关键词: Clinical outcomes;    dialysis membranes;    hemodialysis;    high-flux;    medium cutoff;   

DOI  :  

来源: DOAJ

【 摘 要 】

Rationale & Objective: This study investigated the effects on patients’ outcomes of using medium cutoff (MCO) versus high-flux (HF) dialysis membranes. Study Design: A retrospective, observational, multicenter, cohort study. Setting & Participants: Patients aged greater than 18 years receiving hemodialysis at the Baxter Renal Care Services dialysis network in Colombia. The inception of the cohort occurred from September 1, 2017, to November 30, 2017, with follow-up to November 30, 2019. Exposure: The patients were divided into 2 cohorts according to the dialyzer used at the inception: (1) MCO membrane or (2) HF membrane. Outcomes: Primary outcomes were the hospitalization rate from any cause and hospitalization days per patient-year. Secondary outcomes were acute cardiovascular events and mortality rates from any cause and secondary to cardiovascular causes. Laboratory parameters were assessed throughout the 2-year follow-up period. Analytical Approach: Descriptive statistics were used to report population characteristics. Inverse probability of treatment weighting was applied to each group before analysis. All categorical variables were compared using Pearson’s χ2 test, and continuous variables were analyzed with the t test. Baseline differences between groups with a value of >10% were considered clinically meaningful. Laboratory variables were measured at 5 consecutive time points. A between-patient effect was analyzed using a split-plot factorial analysis of variance. Results: The analysis included 1,098 patients, of whom 564 (51.3%) were dialyzed with MCO membranes and 534 (48.7%) with HF membranes. Patients receiving hemodialysis with MCO membranes had a lower all-cause hospitalization incidence rate (IR) per patient-year (IR = 0.93; 95% CI, 0.82-1.03) than those receiving hemodialysis with HF membranes (IR = 1.13; 95% CI, 0.96-1.30), corresponding to a significant incident rate ratio (MCO/HF) of 0.82 (95% CI, 0.68-0.99; P = 0.04). The frequency of nonfatal cardiovascular events showed statistical significance, with a lower incidence in the MCO group (incident rate ratio = 0.66; 95% CI, 0.46-0.96; P = 0.03). No statistically significant differences in all-cause time until death were observed (P = 0.48). Albumin levels were similar between the 2 dialyzer cohorts. Limitations: Despite the robust statistical analysis, there remains the possibility that unmeasured variables may still generate residual imbalance and, therefore, skew the results. Conclusions: The incidences of hospitalization and cardiovascular events in patients receiving hemodialysis were lower when dialyzed with MCO membranes than HF membranes. A randomized controlled trial would be desirable to confirm these results. Trial Registration: Clinical Trials.gov, ISRCTN12403265.

【 授权许可】

Unknown