The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

High-flux versus low-flux membranes for end-stage kidney disease

High-flux versus low-flux membranes for end-stage kidney disease
High-flux versus low-flux membranes for end-stage kidney disease
BACKGROUND: Clinical practice guidelines regarding the use of high-flux haemodialysis membranes vary widely.

OBJECTIVES: We aimed to analyse the current evidence reported for the benefits and harms of high-flux and low-flux haemodialysis.

SEARCH METHODS: We searched Cochrane Renal Group's specialised register (July 2012), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1948 to March 2011), and EMBASE (1947 to March 2011) without language restriction.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared high-flux haemodialysis with low-flux haemodialysis in people with end-stage kidney disease (ESKD) who required long-term haemodialysis.

DATA COLLECTION AND ANALYSIS: Data were extracted independently by two authors for study characteristics (participants and interventions), risks of bias, and outcomes (all-cause mortality and cause-specific mortality, hospitalisation, health-related quality of life, carpal tunnel syndrome, dialysis-related arthropathy, kidney function, and symptoms) among people on haemodialysis. Treatment effects were expressed as a risk ratio (RR) or mean difference (MD), with 95% confidence intervals (CI) using the random-effects model.

MAIN RESULTS: We included 33 studies that involved 3820 participants with ESKD. High-flux membranes reduced cardiovascular mortality (5 studies, 2612 participants: RR 0.83, 95% CI 0.70 to 0.99) but not all-cause mortality (10 studies, 2915 participants: RR 0.95, 95% CI 0.87 to 1.04) or infection-related mortality (3 studies, 2547 participants: RR 0.91, 95% CI 0.71 to 1.14). In absolute terms, high-flux membranes may prevent three cardiovascular deaths in 100 people treated with haemodialysis for two years. While high-flux membranes reduced predialysis beta-2 microglobulin levels (MD -12.17 mg/L, 95% CI -15.83 to -8.51 mg/L), insufficient data were available to reliably estimate the effects of membrane flux on hospitalisation, carpal tunnel syndrome, or amyloid-related arthropathy. Evidence for effects of high-flux membranes was limited by selective reporting in a few studies. Insufficient numbers of studies limited our ability to conduct subgroup analyses for membrane type, biocompatibility, or reuse. In general, the risk of bias was either high or unclear in the majority of studies.

AUTHORS' CONCLUSIONS: High-flux haemodialysis may reduce cardiovascular mortality in people requiring haemodialysis by about 15%. A large well-designed RCT is now required to confirm this finding.
1469-493X
CD005016
Palmer, S.C.
0e973d87-2499-45b4-bf64-aed9a7cefefb
Rabindranath, K.S.
f78daf66-8dbb-4631-a4ca-87b1f804fe04
Craig, J.C.
2d952295-33e1-4667-ae4b-9515462fbaa1
Roderick, P.J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Locatelli, F.
9de7c5b4-39fd-4e72-938e-6d0b26c69a3f
Strippoli, G.F.
1c3095c2-49c6-4046-8f7a-b1cf53b1c26f
Palmer, S.C.
0e973d87-2499-45b4-bf64-aed9a7cefefb
Rabindranath, K.S.
f78daf66-8dbb-4631-a4ca-87b1f804fe04
Craig, J.C.
2d952295-33e1-4667-ae4b-9515462fbaa1
Roderick, P.J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Locatelli, F.
9de7c5b4-39fd-4e72-938e-6d0b26c69a3f
Strippoli, G.F.
1c3095c2-49c6-4046-8f7a-b1cf53b1c26f

Palmer, S.C., Rabindranath, K.S., Craig, J.C., Roderick, P.J., Locatelli, F. and Strippoli, G.F. (2012) High-flux versus low-flux membranes for end-stage kidney disease. Cochrane Database of Systematic Reviews, 9, CD005016. (doi:10.1002/14651858.CD005016.pub2.Review). (PMID:22972082)

Record type: Article

Abstract

BACKGROUND: Clinical practice guidelines regarding the use of high-flux haemodialysis membranes vary widely.

OBJECTIVES: We aimed to analyse the current evidence reported for the benefits and harms of high-flux and low-flux haemodialysis.

SEARCH METHODS: We searched Cochrane Renal Group's specialised register (July 2012), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1948 to March 2011), and EMBASE (1947 to March 2011) without language restriction.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared high-flux haemodialysis with low-flux haemodialysis in people with end-stage kidney disease (ESKD) who required long-term haemodialysis.

DATA COLLECTION AND ANALYSIS: Data were extracted independently by two authors for study characteristics (participants and interventions), risks of bias, and outcomes (all-cause mortality and cause-specific mortality, hospitalisation, health-related quality of life, carpal tunnel syndrome, dialysis-related arthropathy, kidney function, and symptoms) among people on haemodialysis. Treatment effects were expressed as a risk ratio (RR) or mean difference (MD), with 95% confidence intervals (CI) using the random-effects model.

MAIN RESULTS: We included 33 studies that involved 3820 participants with ESKD. High-flux membranes reduced cardiovascular mortality (5 studies, 2612 participants: RR 0.83, 95% CI 0.70 to 0.99) but not all-cause mortality (10 studies, 2915 participants: RR 0.95, 95% CI 0.87 to 1.04) or infection-related mortality (3 studies, 2547 participants: RR 0.91, 95% CI 0.71 to 1.14). In absolute terms, high-flux membranes may prevent three cardiovascular deaths in 100 people treated with haemodialysis for two years. While high-flux membranes reduced predialysis beta-2 microglobulin levels (MD -12.17 mg/L, 95% CI -15.83 to -8.51 mg/L), insufficient data were available to reliably estimate the effects of membrane flux on hospitalisation, carpal tunnel syndrome, or amyloid-related arthropathy. Evidence for effects of high-flux membranes was limited by selective reporting in a few studies. Insufficient numbers of studies limited our ability to conduct subgroup analyses for membrane type, biocompatibility, or reuse. In general, the risk of bias was either high or unclear in the majority of studies.

AUTHORS' CONCLUSIONS: High-flux haemodialysis may reduce cardiovascular mortality in people requiring haemodialysis by about 15%. A large well-designed RCT is now required to confirm this finding.

This record has no associated files available for download.

More information

Published date: 12 September 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 350117
URI: http://eprints.soton.ac.uk/id/eprint/350117
ISSN: 1469-493X
PURE UUID: 5104832a-5081-4796-9b8c-5cc548336d1a
ORCID for P.J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 18 Mar 2013 15:04
Last modified: 26 Nov 2021 02:37

Export record

Altmetrics

Contributors

Author: S.C. Palmer
Author: K.S. Rabindranath
Author: J.C. Craig
Author: P.J. Roderick ORCID iD
Author: F. Locatelli
Author: G.F. Strippoli

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×