Effect of dialyzer membrane materials on survival in chronic hemodialysis patients: Results from the annual survey of the Japanese Nationwide Dialysis Registry.
Effect of dialyzer membrane materials on survival in chronic hemodialysis patients: Results from the annual survey of the Japanese Nationwide Dialysis Registry.
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DOI：
10.1371/journal.pone.0184424
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Renal Data Registry Committee, Japanese Society for Dialysis Therapy
中科院分区：
文献类型：
--
作者：
Abe M;Hamano T;Wada A;Nakai S;Masakane I;Renal Data Registry Committee, Japanese Society for Dialysis Therapy
关于哪种类型的透析膜在慢性血液透析患者中预后良好的信息很少。因此，我们从日本全国血液透析患者登记中进行了一项队列研究，以建立不同透析膜与死亡率之间的联系。我们从2008年到2009年对142,412名维持性血液透析患者(女性，39.1%；平均年龄64.8±12.3岁；平均透析时间7[4-12]年)进行了为期一年的跟踪调查。我们纳入了七种高通量透析膜的患者，包括三醋酸酯(CTA)、乙烯-乙烯醇(EVAL)、聚丙烯腈(PAN)、聚酯聚合物合金(PEPA)、聚醚砜(PES)、聚甲基丙烯酸甲酯(PMMA)和聚砜(PS)。用COX回归估计基线透析器与全因死亡率之间的关系，作为危险比(HR)和调整潜在混杂因素的1年死亡率的95%可信区间，并进行倾向评分匹配分析。每种膜治疗的患者分布如下：PS(56.0%)、CTA(17.3%)、PES(12.0%)、PEPA(7.5%)、PMMA(4.9%)、PAN(1.2%)和EVAL(1.1%)。当使用基本因素调整数据时，以PS为参照组，除PES组外，所有组的死亡率都显著高于对照组。在进一步调整透析相关因素的数据后，CTA、EVAL和PEPA组的HR显著较高。在进一步调整营养和炎症相关因素的数据后，PMMA和PES组的HRs明显低于PS组。在倾向评分匹配后，PMMA组的HR显著低于PS组。结果提示，使用不同类型的膜可能会影响血液透析患者的死亡率。然而，需要进一步的长期前瞻性研究来澄清这些发现，包括PMMA膜的使用是否可以改善预后。
Little information is available regarding which type of dialyzer membrane results in good prognosis in patients on chronic hemodialysis. Therefore, we conducted a cohort study from a nationwide registry of hemodialysis patients in Japan to establish the association between different dialyzer membranes and mortality rates. We followed 142,412 patients on maintenance hemodialysis (female, 39.1%; mean age, 64.8 ± 12.3 years; median dialysis duration, 7 [4–12] years) for a year from 2008 to 2009. We included patients treated with seven types of high-flux dialyzer membranes at baseline, including cellulose triacetate (CTA), ethylene vinyl alcohol (EVAL), polyacrylonitrile (PAN), polyester polymer alloy (PEPA), polyethersulfone (PES), polymethylmethacrylate (PMMA), and polysulfone (PS). Cox regression was used to estimate the association between baseline dialyzers and all-cause mortality as hazard ratios (HRs) and 95% confidence intervals for 1-year mortality adjusting for potential confounders, and propensity score matching analysis was performed. The distribution of patients treated with each membrane was as follows: PS (56.0%), CTA (17.3%), PES (12.0%), PEPA (7.5%), PMMA (4.9%), PAN (1.2%), and EVAL (1.1%). When data were adjusted using basic factors, with PS as a reference group, the mortality rate was significantly higher in all groups except for the PES group. When data were further adjusted for dialysis-related factors, HRs were significantly higher for the CTA, EVAL, and PEPA groups. When the data were further adjusted for nutrition-and inflammation-related factors, HRs were significantly lower for the PMMA and PES groups compared with the PS group. After propensity score matching, HRs were significantly lower for the PMMA group than for the PS group. The results suggest that the use of different membrane types may affect mortality in hemodialysis patients. However, further long-term prospective studies are needed to clarify these findings, including whether the use of the PMMA membrane can improve prognosis.
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