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Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study.

Publication ,  Journal Article
Allon, M; Depner, TA; Radeva, M; Bailey, J; Beddhu, S; Butterly, D; Coyne, DW; Gassman, JJ; Kaufman, AM; Kaysen, GA; Lewis, JA; Schwab, SJ ...
Published in: J Am Soc Nephrol
July 2003

Infection is the second most common cause of death among hemodialysis patients. A predefined secondary aim of the HEMO study was to determine if dialysis dose or flux reduced infection-related deaths or hospitalizations. The effects of dialysis dose, dialysis membrane, and other clinical parameters on infection-related deaths and first infection-related hospitalizations were analyzed using Cox regression analysis. Among the 1846 randomized patients (mean age, 58 yr; 56% female; 63% black; 45% with diabetes), there were 871 deaths, of which 201 (23%) were due to infection. There were 1698 infection-related hospitalizations, yielding a 35% annual rate. The likelihood of infection-related death did not differ between patients randomized to a high or standard dose (relative risk [RR], 0.99 [0.75 to 1.31]) or between patients randomized to high-flux or low-flux membranes (RR, 0.85 [0.64 to 1.13]). The relative risk of infection-related death was associated (P < 0.001 for each variable) with age (RR, 1.47 [1.29 to 1.68] per 10 yr); co-morbidity score (RR, 1.46 [1.21 to 1.76]), and serum albumin (RR, 0.19 [0.09 to 0.41] per g/dl). The first infection-related hospitalization was related to the vascular access in 21% of the cases, and non-access-related in 79%. Catheters were present in 32% of all study patients admitted with access-related infection, even though catheters represented only 7.6% of vascular accesses in the study. In conclusion, infection accounted for almost one fourth of deaths. Infection-related deaths were not reduced by higher dose or by high flux dialyzers. In this prospective study, most infection-related hospitalizations were not attributed to vascular access. However, the frequency of access-related, infection-related hospitalizations was disproportionately higher among patients with catheters compared with grafts or fistulas.

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Published In

J Am Soc Nephrol

DOI

ISSN

1046-6673

Publication Date

July 2003

Volume

14

Issue

7

Start / End Page

1863 / 1870

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Risk Factors
  • Risk
  • Renal Dialysis
  • Randomized Controlled Trials as Topic
  • Prospective Studies
  • Proportional Hazards Models
  • Middle Aged
  • Male
 

Citation

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Allon, M., Depner, T. A., Radeva, M., Bailey, J., Beddhu, S., Butterly, D., … HEMO Study Group, . (2003). Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol, 14(7), 1863–1870. https://doi.org/10.1097/01.asn.0000074237.78764.d1
Allon, Michael, Thomas A. Depner, Milena Radeva, James Bailey, Srinivasan Beddhu, David Butterly, Daniel W. Coyne, et al. “Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study.J Am Soc Nephrol 14, no. 7 (July 2003): 1863–70. https://doi.org/10.1097/01.asn.0000074237.78764.d1.
Allon M, Depner TA, Radeva M, Bailey J, Beddhu S, Butterly D, et al. Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol. 2003 Jul;14(7):1863–70.
Allon, Michael, et al. “Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study.J Am Soc Nephrol, vol. 14, no. 7, July 2003, pp. 1863–70. Pubmed, doi:10.1097/01.asn.0000074237.78764.d1.
Allon M, Depner TA, Radeva M, Bailey J, Beddhu S, Butterly D, Coyne DW, Gassman JJ, Kaufman AM, Kaysen GA, Lewis JA, Schwab SJ, HEMO Study Group. Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol. 2003 Jul;14(7):1863–1870.

Published In

J Am Soc Nephrol

DOI

ISSN

1046-6673

Publication Date

July 2003

Volume

14

Issue

7

Start / End Page

1863 / 1870

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Risk Factors
  • Risk
  • Renal Dialysis
  • Randomized Controlled Trials as Topic
  • Prospective Studies
  • Proportional Hazards Models
  • Middle Aged
  • Male