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[Do convective treatments significantly reduce morbidity and mortality?].

Abstract
Standard hemodialysis is a far from ideal treatment for uremia since the morbidity and mortality of patients on hemodialysis are still significantly higher than those of non-hemodialyzed subjects with similar demographic characteristics. Because it has been suggested that the cause could lie in the inadequate removal of ''middle molecules'' by standard hemodialyis, two alternative treatments have been proposed: high-efficiency hemodialyis and high-flux hemodialyis. The 2002 results of the HEMO study showed that both these treatments are associated with a non-significant reduction in the relative risk of death (4% and 8%, respectively). The MPO study, which - unlike the HEMO study - enrolled only incident cases and not did not allow reuse of dialyzers, evaluated the mortality rate with high-flux and low-flux hemodialysis in a sicker population, i.e., patients with hypoalbuminemia, and showed a significant reduction in the relative risk of death especially in patients with diabetes. In an attempt to define the clinical impact of hemodiafiltration, some of the efficacy data from clinical studies are reviewed in light of a number of factors that may be related to the high mortality among hemodialysis patients. The current state of affairs suggests it is reasonable to prefer high-flux hemodialysis in sicker patients, especially diabetics. Moreover, the use of ultrapure dialysis fluid is recommended to reduce chronic inflammation and its consequences.
AuthorsC Manzoni, A Cavalli, G Pontoriero, S Di Filippo, F Locatelli
JournalGiornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia (G Ital Nefrol) 2009 Mar-Apr Vol. 26 Suppl 45 Pg. S16-9 ISSN: 0393-5590 [Print] Italy
Vernacular TitleI trattamenti convettivi riducono significativamente morbilita' e mortalita'?
PMID19382089 (Publication Type: English Abstract, Journal Article, Review)
Topics
  • Evidence-Based Medicine
  • Humans
  • Italy (epidemiology)
  • Randomized Controlled Trials as Topic
  • Renal Dialysis (methods)
  • Risk Assessment
  • Survival Rate
  • Uremia (epidemiology, mortality, therapy)

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