Effect of different synthetic membranes on laboratory parameters and survival in chronic haemodialysis patients

Abstract

Background. A number of studies suggested that the type of dialysis membrane is associated with differences in long-term outcome of patients undergoing haemodialysis, both in terms of morbidity and mortality. In the majority of dialysis units, synthetic membranes are being used. However, no studies are available so far for comparison between different biocompatible membranes. Therefore, we studied the influence of high- and low-flux polysulphone membranes (PS) in comparison with polymethylmethacrylate (PMMA) membranes on mortality and morbidity on the basis of various laboratory parameters.Methods. In a cohort study, data of 260 consecutive haemodialysis patients entering our dialysis unit in the years 2003–07 were collected, comparing 435 PS patient-years and 85 PMMA patient-years. PMMA membranes (n = 33) were used for those patients who did not tolerate (e.g. for pruritus) PS membranes (n = 227). Low-flux dialysers (n = 233) were compared with high-flux (n = 37). Laboratory values were evaluated by unpaired t-test, and mortality was evaluated by log-rank test and Cox regression analysis adjusted for age, diabetes and laboratory parameters.Results. Patients in our dialysis unit had a high cardiovascular risk as demonstrated by a proportion of 63% of peripheral arterial disease. Despite this, cumulative survival was almost 60% after 5 years on dialysis. It was slightly but not significantly higher in patients on PMMA (68%) compared with PS dialysers (54%) and on high-flux (61%) versus low-flux membranes (54%). After accounting for the confounding effect of age and diabetes in the multivariate Cox regression analysis, there was no impact of the membranes used (high- or low-flux, PMMA or PS) on survival. Only age at the onset of dialysis showed a significant influence on survival (P ≤ 0.001). Independent predictors of mortality in all patients in the multivariate Cox regression analysis were age, haemoglobin, leucocytes, C-reactive protein (CRP) and creatinine. Laboratory parameters between the high- and low- flux groups were not different. PS-treated patients showed significantly (P ≤ 0.05) higher values for leucocytes, thrombocytes, ferritin, and CRP and lower values for haemoglobin, transferrin, creatinine, uric acid, creatine kinase (CK), and sodium than PMMA-treated patients. Irrespective of the membrane used, in deceased patients, the following laboratory values were higher than for patients alive: leucocytes, thrombocytes, ferritin and CRP; the following were lower: haemoglobin, iron, total protein, urea, creatinine, uric acid and CK.Conclusions. The data of 260 severely ill haemodialysis patients showed a slightly, but not significantly, reduced mortality in patients treated with PMMA membranes in comparison with PS and with high-flux membranes compared with low-flux. High- or low-flux membranes exhibited no difference in laboratory values. However, in PMMA patients, laboratory data with respect to inflammation, anaemia and nutrition were significantly improved compared with the PS group. A similarly positi...

High-Performance Membrane Dialyzers and Mortality in Hemodialysis Patients: A 2-Year Cohort Study from the Annual Survey of the Japanese Renal Data Registry

“…Kreusser et al [38] reported that the cumulative 5-year survival rate for dialysis patients treated with PMMA membrane is higher than that of patients treated with PS membrane (68 vs. 54%). PES membranes are a variant of PS, designed for better clearance of high-molecular weight toxins while restricting the albumin passage.…”

Influence of Dialysis Modality and Membrane Flux on Quality of Life in Hemodialysis Patients

“…16,17 The results of previous studies that evaluated the possible clinical advantages of HDF in comparison with HD are not consistent, and it is not possible to make any precise conclusion out of them. [17][18][19][20][21] Compared with low-flux dialysis, high-flux HD might have a beneficial effect on mortality and clinical outcomes in the patients [22][23][24][25][26][27] or not. 28 The use of synthetic high-flux membranes should be considered to delay the longterm complication of HD therapy: amyloidosis, hyperphosphatemia, cardiovascular risk, and anemia.…”

A new polymethylmetacrylate membrane improves the membrane adhesion of blood components and clinical efficacy

“…9). Previous articles have reported the improvements of various clinical symptoms with the conventional PMMA dialyzers [3][4][5][9][10][11][12][13][14][15][16][17][18][19]. Protein adsorption by PMMA membranes is considered one factor associated with these improvements.…”