Subgroup analyses suggest a higher dose of hemodialysis (blood passed through an artificial kidney to remove waste products and toxins) may improve survival in women, however, and a more permeable membrane may reduce the risk for cardiovascular complications in patients on hemodialysis.
The findings appear in the Dec. 19 issue of The New England Journal of Medicine.
"The importance of this study is that it is the first prospectively designed study to evaluate what happens when you apply higher doses of dialysis and highly permeable artificial kidneys in a clinical trial," said Dr. Robert Toto, professor of internal medicine and senior author of the study. "We learned a higher dose of dialysis and a higher permeable membrane is not enough. We've got to do better. We've got to do more to help improve the quality and duration of life of patients on hemodialysis."
UT Southwestern was among 15 U.S. clinical centers participating in a randomized trial of about 1,850 patients with severe kidney failure who required hemodialysis. The objectives of the Hemodialysis Study, designed in 1994, were to determine if a high dose of dialysis is better than a standard dose and whether dialysis with a highly permeable artificial kidney benefits patients on hemodialysis for end-stage kidney disease (ESKD), both in improving survival and reducing hospitalization.
ESKD, Toto said, is a condition in which kidney failure is so severe that death occurs unless kidney function is replaced by either dialysis or transplantation. It is increasing in the United States, and morbidity and mortality of ESKD patients is high, even for those on dialysis.