ABSTRACT
BACKGROUND: The use of biocompatible high-flux membranes is more efficient than low-flux membranes in controlling a number of hemodialysis-related diseases. The aim of this cooperative study was to evaluate the 6-month effect of a switch from low- to high-flux dialysers on patients treated in 39 Spanish dialysis centres. METHODS: The clinical data used in this analysis were prospectively collected by the EuCliD database, developed to monitor the quality of treatment delivered in a large network of European Dialysis Centres. Inclusion criteria for the study were the condition of end-stage renal disease (ESRD) on chronic hemodialysis and low-flux dialysis for at least six months before the switch to high-flux dialysis. Of 1,543 patients enrolled in the study between 2000 and 2001, 1,046 patients were considered for the analysis. 497 patients were excluded because they did not complete the follow-up. Outcome measures were the reduction of pre-dialysis beta-2 microglobulin, the improvement of anemia or reduction in rHu-EPO dose required to maintain best correction of anemia, reduction of inflammatory parameters (CRP), improvement in lipid profile (Total and HDL cholesterol, tryglycerides), maintenance of nutritional status. Albumin and "dry" (post-hemodialysis) body weight were both evaluated as nutritional indexes. RESULTS: During the six months of high-flux hemodialysis, there was a significant increase in hemoglobin (from 11.55 +/- 1.41 to 11.88 +/- 1.43 g/L; p < 0.001). Considering the temporarily untreated patients on a 0 U/week dose, erythropoietin remained stable (from 5,670 +/- 4,199 to 5,657 +/- 4,411 U/week). During the second part of the follow-up, the lipid profile significantly improved (Fig. 3). Total cholesterol and triglycerides decreased significantly (p < 0.001), while HDL cholesterol increased (p = 0.006). Calculated levels of LDL cholesterol also significantly decreased (p = 0.001). Dry body weight remained stable (64.7 +/- 11.9 vs. 64.7 +/- 12.0 kg) as well as in albumin levels (3.93 +/- 0.43 vs. 3.94 +/- 0.43 g/dL) between the two modalities of treatment. The level of beta2-microglobulin significantly decreased during high-flux dialysis (33.5 +/- 14.4 vs. 26.3 +/- 8.6 mg/dL, p < 0.001). CONCLUSION: All above mentioned results may have as a common denominator an improved blood purification from uremic toxins and a reduced level of chronic sub-clinical inflammation. All together, these results seem to confirm the superiority of high-flux dialysis in terms of clinical and physiological outcomes.
Subject(s)
Amyloidosis/prevention & control , Anemia/prevention & control , C-Reactive Protein/analysis , Cholesterol, LDL/analysis , Kidney Failure, Chronic/therapy , Membranes, Artificial , Renal Dialysis/instrumentation , Aged , Amyloidosis/etiology , Anemia/etiology , Blood Chemical Analysis , Female , Hemodialysis Units, Hospital , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/mortality , Male , Middle Aged , Probability , Prognosis , Prospective Studies , Renal Dialysis/adverse effects , Renal Dialysis/methods , Risk Assessment , Severity of Illness Index , Survival Rate , Treatment OutcomeABSTRACT
Nos planteamos evaluar el manejo de la anemia en los centros Fresenius Medical Care de España. Presentamos datos de 4.426 pacientes en hemodiálisis prevalentes en el año 2001 recogidos en la base de datos European Clinical Database (EuCliD®). Evaluamos mediante el índice de respuesta a la Eritropoyetina (IRE): cociente entre dosis de Eritropoyetina (UI/kg de peso/semana) y Hemoglobina (g/dl), la respuesta a la eritropoyetina en función de diferentes variables. Comparamos nuestros resultados con los aparecidos en el estudio ESAM2.El 70 por ciento de la población alcanza una hemoglobina superior a 11 g/dl utilizando dosis de eritropoyetina de 111,9 UI/kg de peso/semana (n = 3.700; SD 74,9).Resultado similar al medido al inicio del ESAM2 donde es del 65 por ciento. La dosis empleada de eritropoyetina es ligeramente superior a la utilizada en el ESAM2 (111,9 UI/kg de peso/semana y 105,5 UI/kg de peso/semana respectivamente), quizá relacionado con la menor proporción de pacientes en tratamiento por vía subcutánea (70 por ciento frente a 79 por ciento) y con la inclusión de pacientes en diálisis peritoneal dentro del estudio ESAM2. Efectivamente según nuestros datos, el IRE es mayor en los pacientes que reciben tratamiento por vía intravenosa en comparación con la vía subcutánea (11,66 y 9,6 respectivamente p 20 por ciento (135 UI/kg de peso/semana frente a 110,52 UI/kg de peso/semana respectivamente, p < 0,005).Observamos también que variables relacionados de forma directa o indirecta con la inflamación como la elevación de proteína C reactiva, la hipoalbuminemia o la elevación de la ferritina, presentan peor respuesta a la eritropoyetina (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Renal Dialysis , Spain , Erythropoietin , Anemia , Renal Insufficiency, ChronicABSTRACT
We present the results on Anaemia Management in Fresenius Medical Care Spain dialysis centres as reported by EuCliD (European Clinical Database), evaluating a population of 4,426 patients treated in Spain during the year 2001. To analyse the erythropoietin dose and the haemoglobin levels we divided the population in two groups according to the time with dialysis treatment: patients treated less than six months and patients between six months, and four years on therapy. We compared our results with the evidence based recommendations Guidelines: the European Best Practice Guidelines (EBPG) and the US National Kidney Foundation (NKF-K/DOQI). We also compared our results with those presented by the ESAM2 on 2,618 patients on dialysis in Spain carried out in the second half of the year 2000. We observed that 70% of the population reaches an haemoglobin value higher that 11 g/dl, with a mean erythropoietin (rHu-EPO) dose of 111.9 Ul/kg weight/week (n = 3,700; SD 74.9). However, for those patients on treatment for less than six months, the mean Haemoglobin only reaches 10.65 g/dl (n = 222; SD 1.4). The rHu-EPO was administrated subcutaneously in 70.2% of the patients. About the iron therapy, 86% of the patients received iron treatment and the administration route was intravenous in 93% of the population. The ferritin levels were below 100 micrograms/dl in 10% of the patients and 26.4% showed a transferrin saturation index (TSAT) below 20%. The erythropoieting resistance index (ERI), as rHu-EPO/haemoglobin, has been used to evaluate the response to rHu-Epo, according to different variables. It was observed that the following factors lead to a higher rHu-EPO resistance: intravenous rHu-EPO as administration route, the presence of hypoalbuminemia, increase of protein C reactive, Transferrin saturation below 20% and starting dialysis during the last six months.
