Cardiovascular and non-cardiovascular mortality rates for people commencing haemodialysis are nearly 30 to 50 times higher than for the general population. It has been suggested that removal of larger solutes across high-flux haemodialysis membranes may better reflect normal kidney function and improve cardiovascular outcomes versus low-flux haemodialysis. Here we report results from a meta-analysis investigating this hypothesis.
Palmer and colleagues performed a meta-analysis entitled “High-flux versus low-flux membranes for end-stage kidney disease (Review)” of 33 randomized controlled trials included 3820 people with end-stage renal disease (ESRD). Results showed that high-flux dialysis membranes reduced deaths from cardiovascular causes by 17%1 (relative risk [RR] 0.83, 95% confidence interval [CI] 0.70 to 0.99), but did not reduce overall risk of death. In absolute terms, this means that if 100 people were treated with high-flux dialysis for two years, three deaths from cardiovascular causes may be prevented.
While high-flux membranes reduced predialysis beta-2 microglobulin levels compared with low-flux membranes (–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 hospitalization or joint problems.
The authors concluded that high-flux haemodialysis may reduce cardiovascular mortality in people requiring haemodialysis by about 15%. They noted that a large well-designed randomized controlled trial is now required to confirm this finding.
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- Palmer SC, Rabindranath KS, Craig JC et al. High-flux versus low-flux membranes for end-stage kidney disease. Cochrane Database Syst Rev 2012;9:CD005016.