Hemodialysis study results published

December 18, 2002

The most comprehensive, randomized clinical trial of hemodialysis therapy to-date has confirmed the adequacy of current dosage guidelines. The researchers also found that using high-flux filters to remove larger waste molecules from the blood does not help patients live longer. Results appear in the Dec. 19 New England Journal of Medicine.

Patients in the Hemodialysis (HEMO) Study who received a dialysis dose higher than that recommended by National Kidney Foundation guidelines or who used high-flux filters neither lived substantially longer nor stayed out of the hospital more than those who received the currently recommended standard dose or used low-flux filters. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.

"This will be welcome news to the hundreds of thousands of people who are on dialysis in the United States, since our findings support the Foundation's current practice guidelines," said Garabed Eknoyan, M.D., study chair and professor of medicine at Baylor College of Medicine in Houston. "It is reassuring that the dose now recommended is adequate."

The HEMO Study evaluated the prevailing theory that a higher dose of dialysis or high-flux filters improve survival and reduce hospitalizations. Doctors at 15 medical centers recruited more than 1,800 hemodialysis patients and randomly assigned them to high or standard dialysis doses and high- or low-flux filters. Duration of survival was the major outcome studied, but hospitalizations, nutritional status and quality of life were also examined.

While survival and hospitalizations were not substantially different among study groups, there were intriguing, though not definitive, findings for certain patients. The high dose appeared to reduce the risk of death and hospitalization among women, regardless of race and body size, and high-flux filters appeared to reduce the risk of death among patients who had been on hemodialysis more than 3½ years when they joined the study.

"We are getting as much as we can expect out of 3 or 4 hours of dialysis given three times each week. To improve survival and reduce hospitalizations, we are probably going to need radical changes, such as significantly increasing the time on dialysis at each session or by increasing the frequency (number of days) of dialysis, both of which would need to be evaluated," said Eknoyan.

Kidney failure is a growing problem that can be prevented or slowed, but only a fraction of people who are at high risk are screened or managed appropriately. Patients, insurers and the U.S. Government's Medicare program paid nearly $20 billion to treat 379,000 people for kidney failure in 2000. Most are on dialysis (275,000) and most dialysis patients are on hemodialysis (246,000). Nearly 6 percent of all Medicare expenditures for 2000 were for kidney failure. Diabetes and hypertension are leading causes. However, one study found that only 30 percent of diabetics were on a kidney-protecting ACE inhibitor when discharged from the hospital, and another showed that 70 percent of people being treated for high blood pressure are not reaching recommended levels.

Attempting to stem the rising tide of people with kidney failure, NIDDK's National Kidney Disease Education Program (http://www.nkdep.nih.gov) will soon launch grass-roots pilot projects in Atlanta, Cleveland, Baltimore and Jackson, Mississippi, aimed at reducing kidney failure by increasing awareness about early diagnosis and aggressive management of kidney disease.
-end-
Baxter Healthcare, Fresenius Medical Care, R&D Laboratories and Ross Laboratories donated products for the HEMO Study.

Learn about hemodialysis at http://www.niddk.nih.gov/health/kidney/pubs/kidney-failure/treatment-hemodialysis/treatment-hemodialysis.htm#equip.

Additional contact:
Jane DeMouy
301-496-3583

NIH/National Institute of Diabetes and Digestive and Kidney Diseases

Related Kidney Disease Articles from Brightsurf:

Waistline matters in kidney disease
Does fat matter in kidney disease? The investigators found that all measures of higher abdominal fat content (including visceral fat, liver fat, or subcutaneous fat) and slower walk times were associated with increased levels of cardiometabolic risk factors in adults with non-dialysis dependent kidney disease.

Reducing urinary protein for patients with rare kidney disease slows kidney decline
New findings show that reducing the amount of protein in the urine of patients with focal segmental glomerulosclerosis can significantly slow declines in kidney function and extend time before patients' kidneys fail.

Antioxidant agent may prevent chronic kidney disease and Parkinson's disease
Researchers from Osaka University developed a novel dietary silicon-based antioxidant agent with renoprotective and neuroprotective effects.

Acute kidney injury and end stage kidney disease in severe COVID-19
Many COVID-19 patients experience hematuria, proteinuria and elevated serum creatinine concentration early in the course of the disease.

Genes tell a story about diabetic kidney disease
Studying Finnish genes leads to unique revelations about the development of a serious complication of diabetes, and informs an ongoing genomic study of a Singaporean cohort as part of Singapore's Diabetes Study in Nephropathy and other Microvascular Complications (DYNAMO).

New study provides insight into chronic kidney disease
Researchers have further analyzed a known signaling pathway they believe brings them one step closer to understanding the complex physiology of patients with chronic kidney disease (CKD), which might provide a path to new treatment options.

Predicting risk of chronic kidney disease
Data from about 5 million people (with and without diabetes) in 28 countries were used to develop equations to help identify people at increased five-year risk of chronic kidney disease, defined as reduced estimated glomerular filtration rate (eGFR).

A healthy diet may help prevent kidney disease
In an analysis of published studies, a healthy dietary pattern was associated with a 30% lower incidence of chronic kidney disease.

Is kidney failure a man's disease?
A new analysis of the ERA-EDTA Registry [1] reveals a striking gender difference in the incidence and prevalence of end-stage renal disease.

Chronic kidney disease: Everyone's concern
850 million people worldwide are affected by kidney disease. This worrying figure was published last June.

Read More: Kidney Disease News and Kidney Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.