Original InvestigationEffect of dialysis membranes and middle molecule removal on chronic hemodialysis patient survival★
Section snippets
Middle molecule removal
We have chosen vitamin B12 as the molecular marker for evaluating middle molecule removal for both historical and practical reasons. Vitamin B12 (1,355 daltons) has long been used as a marker for middle molecules in a number of in vitro and clinical studies,13 and manufacturers frequently report dialyzer clearances for vitamin B12 determined in vitro as a measure of the porosity of the dialysis membrane. Although the validity of projecting in vitro clearances of vitamin B12 to the clinical HD
Results
The primary results from these analyses are shown in Tables 2 and 3 where the relative mortality risk was calculated for higher rates of middle molecule removal as assessed by either TCVB12 or KB12 t/V, respectively.Table 2 shows that patients treated with a 10% higher calculated TCVB12 had an approximately 5% lower risk of mortality (RR = 0.953, P < 0.0001 v 1.000) when urea Kt/V remained constant. For comparison, patients treated with a 0.1 unit higher value of urea Kt/V had a 7.5% lower risk
Discussion
The results of the analyses performed in this study show that the use of a dialyzer with high calculated middle molecule removal rates is associated with a reduced risk of mortality in chronic HD patients independent of urea Kt/V. To minimize bias in these analyses, patients were excluded from the study sample when we could not accurately evaluate parameters that have been previously shown to influence patient survival, such as urea Kt/V. Furthermore, we excluded patients who had been on
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Received April 1, 1998; accepted in revised form July 31, 1998.
Supported by USRDS, DVA Medical Research Funds and the Dialysis Research Foundation, Ogden, UT.
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Address reprint requests to John K. Leypoldt, PhD, Dumke Building 535, University of Utah, Salt Lake City, UT 84112. E-mail: [email protected]