![]() Two treatment-related factors implicated in the substantial mortality and morbidity among patients undergoing maintenance hemodialysis 1 are the dose of dialysis delivered and the size of molecules removed. guidelines or from the use of a high-flux membrane. Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. Possible benefits of the dose or flux interventions were suggested in two of seven prespecified subgroups of patients. The main secondary outcomes (first hospitalization for cardiac causes or death from any cause, first hospitalization for infection or death from any cause, first 15 percent decrease in the serum albumin level or death from any cause, and all hospitalizations not related to vascular access) also did not differ significantly between either the dose groups or the flux groups. The primary outcome, death from any cause, was not significantly influenced by the dose or flux assignment: the relative risk of death in the high-dose group as compared with the standard-dose group was 0.96 (95 percent confidence interval, 0.84 to 1.10 P=0.53), and the relative risk of death in the high-flux group as compared with the low-flux group was 0.92 (95 percent confidence interval, 0.81 to 1.05 P=0.23). Flux, estimated on the basis of beta 2-microglobulin clearance, was 3☗ ml per minute in the low-flux group and 34☑1 ml per minute in the high-flux group. In the standard-dose group, the mean (±SD) urea-reduction ratio was 66.3☒.5 percent, the single-pool Kt/V was 1.32☐.09, and the equilibrated Kt/V was 1.16☐.08 in the high-dose group, the values were 75.2☒.5 percent, 1.71☐.11, and 1.53☐.09, respectively. We undertook a randomized clinical trial in 1846 patients undergoing thrice-weekly dialysis, using a two-by-two factorial design to assign patients randomly to a standard or high dose of dialysis and to a low-flux or high-flux dialyzer. ![]() The effects of the dose of dialysis and the level of flux of the dialyzer membrane on mortality and morbidity among patients undergoing maintenance hemodialysis are uncertain. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. ![]() Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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