MORTALITY AND MORBIDITY IN HEMODIALYSIS--CLINICAL CENTER

进入终末期肾病（ESRD）的患者人群 自成立以来，美国（US）的计划每年都在增长， 联邦资金支持这个项目。 1990年，医疗保险的估计成本 超过50亿美元，近20万患者正在接受治疗。 该人群的主要治疗方式是中心内治疗 血液透析（HD）。 最近对美国HD人群的分析表明， 显示令人不安的高死亡率（23.4%）， 与一般人口相比的预期寿命。 其他国家 报告说，他们的HD人群的死亡率要低得多。是否 美国HD人口可以与其他国家相比， 问题 其他国家的报告显示， 患者接受的HD往往高于美国。 这一事实 提出了一个问题，是否足够的HD是一个主要因素， 美国患者死亡率过高。 美国国立卫生研究院开展了一项重大研究， 解决这些被称为HD死亡率和死亡率（MMHD）的问题 Study. 这是一项为期五年的多中心研究， 分配至4种不同HD处方中的1种。不同的处方 包括不同的HD充分性（1的KT/V对1的KT/V）。 1.4)和两种不同的血液透析器膜（生物不相容性与 生物相容性膜）。 因此，患者将被随机分配至1/4 不同的协议。 将测量死亡率以及继发性 结果，如住院和生活质量。 该提案旨在申请成为15个“临床中心”之一， study. 此应用程序表明，罗切斯特大学 专业知识和足够的HD患者人群， 招募患者并完成本研究。

The population of patients entering the End-Stage Renal Disease (ESRD) Program in the United States (US) has grown each year since inception of Federal funding for the program. In 1990 the estimated cost to Medicare was over $5 billion and nearly 200,000 patients were receiving treatment. The major modality of therapy for this population is in-center hemodialysis (HD). Recent analysis of the HD population in the US has revealed disturbingly high mortality rates (23.4%) and marked reduction in life expectancy compared to the general population. Other countries have reported much lower mortality rates in their HD populations. Whether the US HD population can be compared to that of other countries remains a question. Reports from other countries reveal the amount or adequacy of HD received by patients tends to be greater than in the US. This fact raises the question whether adequacy of HD is a major contributor to the excess mortality of US patients. The NIH has instituted a major study to address these issues called the Mortality and Morbidity in HD (MMHD) Study. This is a five year multi-center study of patients randomly assigned to l of 4 different HD prescriptions. The different prescriptions for this study include varying adequacy of HD (KT/V of l versus KT/V of 1.4) and two different hemodialyzer membranes (a bioincompatible versus biocompatible membrane). Thus, patients will be randomized to l of 4 different protocols. Mortality will be measured as well as secondary outcomes such as hospitalizations and quality of life. This proposal is to apply to become 1 of 15 "Clinical Centers" for this study. This application demonstrates that the University of Rochester has the expertise and a sufficient HD patient population to satisfactorily recruit patients and complete this study.