Document Detail


Cerebrovascular disease in maintenance hemodialysis patients: results of the HEMO Study.
MedLine Citation:
PMID:  16377394     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cerebrovascular disease (CBVD) in hemodialysis patients is associated with significant morbidity and mortality. A secondary analysis of CBVD in the Hemodialysis (HEMO) Study was performed. Specific objectives were to: (1) determine risk factors for the presence of CBVD at baseline, (2) assess risk factors for the subsequent occurrence of cerebrovascular deaths, and (3) analyze the effects of dose and flux on cerebrovascular mortality. METHODS: The HEMO Study was a randomized multicenter study evaluating the effects of high-dose versus standard-dose and high-flux versus low-flux hemodialysis. There were 1,846 patients enrolled, with a mean follow-up of 2.84 years. RESULTS: Factors associated with the baseline presence of CBVD included age (P < 0.0001), presence of any cardiac disease (P < 0.0001), and diabetes mellitus (P < 0.0001). There were 65 deaths caused by CBVD (event rate, 1.2/100 patient-years). Multivariate Cox regression using a backward-variables selection procedure showed that diabetes, lower albumin level, greater hematocrit, and lower body mass index at baseline were associated significantly with subsequent CBVD death. There was no effect of flux or dose on overall rate of CBVD deaths. However, an interaction was found between baseline CBVD status and flux intervention on CBVD death (P = 0.016). In the subgroup of patients without the baseline presence of CBVD, high-flux dialysis was associated with a lower risk for death caused by CBVD (P = 0.016). A borderline interaction between years of dialysis therapy and flux on subsequent CBVD death was detected (P = 0.05). The beneficial effect of high flux was evident in those on hemodialysis therapy for longer than 3.7 years (P = 0.012). CONCLUSION: High flux was associated with decreased CBVD mortality in those without known CBVD at baseline and those on hemodialysis therapy for longer than 3.7 years. This secondary analysis strengthens, but does not prove, the hypothesis that high-flux treatment may attenuate the death rate from vascular disease.
Authors:
James A Delmez; Guofen Yan; James Bailey; Gerald J Beck; Srinivasan Beddhu; Alfred K Cheung; George A Kaysen; Andrew S Levey; Mark J Sarnak; Steve J Schwab;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  47     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-26     Completed Date:  2006-02-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  131-8     Citation Subset:  IM    
Affiliation:
Washington University, St Louis, MO, USA. jdelmez@wustl.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Albuminuria / epidemiology
Body Mass Index
Cerebrovascular Disorders / epidemiology*,  mortality,  prevention & control
Comorbidity
Diabetes Mellitus / epidemiology
Female
Hematocrit
Humans
Kidney Failure, Chronic / complications*
Male
Middle Aged
Multicenter Studies as Topic
Proportional Hazards Models
Randomized Controlled Trials as Topic
Renal Dialysis* / methods,  statistics & numerical data
Risk Factors
Severity of Illness Index
Survival Analysis
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
5 UO1 DK49240/DK/NIDDK NIH HHS

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