Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study

Published on Aug 27, 2021in Frontiers of Medicine in China
· DOI :10.3389/FMED.2021.740461
Masanori Abe51
Estimated H-index: 51
(Nihon University),
Ikuto Masakane33
Estimated H-index: 33
+ 3 AuthorsHidetomo Nakamoto33
Estimated H-index: 33
(Saitama Medical University)
Source
Abstract
Background: Dialyzers are classified as low-, high-, and super high-flux membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux, and types IV and V to super high-flux. Here we aimed to clarify the association of dialyzer type with mortality. Methods: This nationwide prospective cohort study analyzed data from the Japanese Society for Dialysis Therapy on 2010 and 2013. We enrolled 238,321 patients on hemodialysis who were divided into low, high, and super high-flux groups in the international classification cohort and into type I to V groups in the Japanese classification cohort. We assessed associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis. Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification cohort, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group (1.12 [1.03-1.22], P = 0.009) and significantly lower in the super high-flux group (0.95 [0.92-0.98], P = 0.006) compared with the high-flux group after adjustment for all confounders. In the Japanese classification cohort, the hazard ratios were significantly higher for types I (1.10 [1.02-1.19], P = 0.015) and II (1.10 [1.02-1.39], P = 0.014) but significantly lower for type V (0.91 [0.88-0.94], P < 0.0001) compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching in both cohorts. Conclusions: Hemodialysis using super high-flux dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.
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#1Theerachai Thammathiwat (NU: Naresuan University)H-Index: 2
#2Khajohn Tiranathanagul (Chula: Chulalongkorn University)H-Index: 17
Last. Somchai Eiam-Ong (Chula: Chulalongkorn University)H-Index: 28
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Although high-volume post-dilution online hemodiafiltration (ol-HDF) is superior to high-flux hemodialysis (HD) in removing all kinds of uremic toxins and improving survival, this treatment is not available in most HD centers. The present study was conducted to compare the effectiveness in removals of protein-bound (indoxyl sulfate, IS), middle-molecule [beta-2 microglobulin (B2M) and alpha-1 microglobulin (A1MG)], and small-molecule uremic toxins between super high-flux HD (SHF-HD), HD with a n...
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#2Masanori Abe (Nihon University)H-Index: 51
#3Ikuto MasakaneH-Index: 33
Last. Hidetomo NakamotoH-Index: 33
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The annual survey questionnaires of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) were sent to 4458 dialysis facilities at the end of 2018; 4402 facilities (98.7%) responded to the facility questionnaire, and 4222 facilities (94.7%) responded to the patient questionnaire. This paper reports the results obtained in regard to several issues: dialysis fluid quality, prescription of hemodialysis and hemodiafiltration, current status of peritoneal dialysis, and glycemic indices...
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#1Kosaku NittaH-Index: 61
#4Norio HanafusaH-Index: 25
Last. Yoshinori OshiroH-Index: 1
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The annual survey of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was sent to 4458 dialysis facilities at the end of 2018; among these facilities, 4402 facilities (98.7%) responded to the facility questionnaire, and 4222 (94.7%) responded to the patient questionnaire. The number of chronic dialysis patients in Japan continues to increase every year; as of the end of 2018, it had reached 339,841 patients, representing 2688 patients per million population. Among the prevale...
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#1Stephan HarmH-Index: 8
#2Claudia Schildböck (Danube University Krems)H-Index: 4
Last. Jens Hartmann (Danube University Krems)H-Index: 11
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Background/Aims: Cytokines are among the main target substances that have to be removed effectively in order to improve the patient’s health status in the treatment of sepsis, septic shock, and liver diseases. Although there are various medical devices commercially available, the success of their clinical use is limited. The aim of this in vitro study was to compare 3 different medical devices with respect to their clearance for the cytokines interleukin-6 (IL-6), IL-8, IL-1β, and tumor necrosis...
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#1Kosaku NittaH-Index: 61
#2Ikuto MasakaneH-Index: 33
Last. Hidetomo NakamotoH-Index: 33
view all 14 authors...
The annual survey of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was conducted for 4413 dialysis facilities at the end of 2017; among which 4360 facilities (98.8%) responded to the facility questionnaire, and 4188 (94.9%) responded to the patient questionnaire. The response rate of the 2017 survey was comparable with the past, even though it was the third year after the new anonymization method. The number of chronic dialysis patients in Japan continues to increase every...
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#1Francisco MaduellH-Index: 21
#2Lida RodasH-Index: 9
Last. Nayra RicoH-Index: 8
view all 12 authors...
: Most high-flux dialyzers can be used in both hemodialysis (HD) and online hemodiafiltration (OL-HDF). However, some of these dialyzers have higher permeability and should not be prescribed for OL-HDF to avoid high albumin losses. The aim of this study was to compare the safety and efficacy of a currently used dialyzer in HD and OL-HDF with those of several other high permeability dialyzers which should only be used in HD. A prospective, single-center study was carried out in 21 patients. Each ...
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#1Mohamed BelmouazH-Index: 5
#2Marc BauwensH-Index: 10
Last. Frank BridouxH-Index: 28
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BACKGROUND: Accumulation of middle-weight uraemic toxins in haemodialysis (HD) patients results in increased morbidity and mortality. Whether medium cut-off HD (MCO-HD) improves removal of middle-weight uraemic toxins remains to be demonstrated. METHODS: This cross-over prospective study included 40 patients randomly assigned to receive either 3 months of MCO-HD followed by 3 months of high-flux HD (HF-HD), or vice versa. The primary endpoint was myoglobin reduction ratio (RR) after 3 months of ...
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: Aggressive removal of middle molecules or larger low-molecular-weight proteins (LMWPs) has been a growing concern following studies on their harmful effects on the mortality and morbidity of chronic dialysis patients. To remove larger LMWPs and some protein-bound uremic toxins (PBUTs), high- and medium-cutoff (HCOs and MCOs, respectively) membranes, convective therapy and protein adsorptive membranes are available. When we use HCO or MCO membranes for convective therapy, we have to take care t...
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: Modern methods in analytical biochemistry have established that uraemia is associated with the retention of proteins, both in their native state and post-translationally modified, over a wide range of molecular weights up to 60 kDa. Evidence is accumulating that these higher molecular weight retention solutes are important uraemic toxins, and therapies such as online haemodiafiltration (HDF), which enhance their removal, are associated with improved outcomes. However, HDF has limitations regar...
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: Recent advances in chemical composition and new production techniques resulted in improved biocompatibility and permeability of dialysis membranes. Among these, the creation of a new class of membranes called medium cut-off (MCO) represents an important step towards improvement of clinical outcomes. Such membranes have been developed to improve the clearance of medium to high molecular weight (MW) solutes (i.e. uraemic toxins in the range of 5-50 kDa). MCO membranes have peculiar retention ons...
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Cited By0
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#1Masanori AbeH-Index: 51
#2Ikuto MasakaneH-Index: 33
Last. Hidetomo NakamotoH-Index: 33
view all 6 authors...
A target Kt/V of > 1.4 and use of a high-flux dialyzer are recommended for patients on hemodialysis. However, there is little information on the relationship between the dialyzer surface area and mortality in these patients. In this nationwide cohort study, we aimed to clarify this relationship by analyzing data from the Japanese Society for Dialysis Therapy for 2010-2013. We enrolled 234,638 patients on hemodialysis who were divided according to quartile for dialyzer surface area into the S gro...
Source
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