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Dialyzer reuse and outcomes of high flux dialysis

Argyropoulos, C and Roumelioti, ME and Sattar, A and Kellum, JA and Weissfeld, L and Unruh, ML (2015) Dialyzer reuse and outcomes of high flux dialysis. PLoS ONE, 10 (6).

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Abstract

© 2015 Argyropoulos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: The bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers. Methods: Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO. Findings: In HEMO, minimally reused ( < 6 times) HF dialyzers were associated with a hazard ratio (HR) of 0.67 (95% confidence interval, 95%CI: 0.48-0.92, p = 0.015), 0.64 (95%CI: 0.44-0.95, p = 0.03), 0.61 (95%CI: 0.41-0.90, p = 0.012), 0.53 (95%CI: 0.28-1.02, p = 0.057) relative to minimally reused LF ones for all cause, cardiovascular, cardiac and infectious mortality respectively. These relationships reversed for extensively reused membranes (p for interaction between reuse and flux < 0.001, p = 0.005) for death from all cause and cardiovascular causes, while similar trends were noted for cardiac and infectious mortality (p of interaction between reuse and flux of 0.10 and 0.08 respectively). Reduction of β2M explained only 1/3 of the effect of minimally reused HF dialyzers on all cause mortality, while non-β2M related factors explained the apparent attenuation of the benefit with more extensively reused dialyzers. Meta-regression of HEMO and MPO estimated an adjusted HR of 0.63 (95% CI: 0.51-0.78) for non-reused HF dialyzers compared with non-reused LF membranes. Conclusions: This secondary analysis and synthesis of two large hemodialysis trials supports the widespread use of HF dialyzers in clinical hemodialysis over the last decade. A mechanistic understanding of the effects of HF dialysis and the reuse process on dialyzers may suggest novel biomarkers for uremic toxicity and may accelerate membrane technology innovations that will improve patient outcomes.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Argyropoulos, C
Roumelioti, ME
Sattar, A
Kellum, JAkellum@pitt.eduKELLUM0000-0003-1995-2653
Weissfeld, L
Unruh, ML
Date: 9 June 2015
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Journal or Publication Title: PLoS ONE
Volume: 10
Number: 6
DOI or Unique Handle: 10.1371/journal.pone.0129575
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Biostatistics
School of Medicine > Critical Care Medicine
Refereed: Yes
Date Deposited: 23 Aug 2016 14:19
Last Modified: 30 Oct 2017 22:56
URI: http://d-scholarship.pitt.edu/id/eprint/28469

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