Krane Vera, Krieter Detlef H, Olschewski Manfred, März Winfried, Mann Johannes F E, Ritz Eberhard, Wanner Christoph
University of Würzburg, Department of Medicine, Division of Nephrology, University Hospital Würzburg.
Am J Kidney Dis. 2007 Feb;49(2):267-75. doi: 10.1053/j.ajkd.2006.11.026.
Effects of dialyzer membrane characteristics on morbidity and mortality are highly controversial.
Post hoc, we analyzed data from the German Diabetes and Dialysis Study that evaluated atorvastatin in high-risk patients. Four groups were identified being constantly dialyzed with high-flux synthetic (n = 241), low-flux synthetic (n = 247), low-flux semisynthetic (n = 119), or cellulosic low-flux membranes (n = 41). Two end points were investigated: (1) a cardiovascular end point consisting of cardiac death, nonfatal myocardial infarction, and stroke and (2) death.
After 4 years of follow-up, adjusted multivariate relative risks (RRs) were calculated. The RR to reach a cardiovascular end point was greater for patients dialyzed with cellulosic low-flux (RR, 2.33; 95% confidence interval [CI], 1.38 to 3.94; P = 0.002), low-flux semisynthetic (RR, 1.92; 95% CI, 1.35 to 2.73; P = 0.0003), or low-flux synthetic membranes (RR, 1.35; 95% CI, 0.99 to 1.85; P = 0.06) than for those treated with high-flux synthetic dialyzers. The likelihood to die was greater with cellulosic low-flux (RR, 4.14; 95% CI, 2.79 to 6.15; P < 0.0001), low-flux semisynthetic (RR, 2.24; 95% CI, 1.66 to 3.02; P < 0.0001), and low-flux synthetic membranes (RR, 1.59; 95% CI, 1.22 to 2.07; P = 0.0006) than with high-flux synthetic membranes. With respect to low-flux synthetic membranes, RRs of mortality for patients using cellulosic low-flux and low-flux semisynthetic membranes were 161% (RR, 2.61; 95 % CI, 1.80 to 3.79; P < 0.0001) and 41% (RR, 1.41; 95% CI, 1.07 to 1.86; P = 0.016) greater. Cellulosic low-flux membrane use was associated with an 85% (RR, 1.85; 95% CI, 1.24 to 2.76; P = 0.0025) greater RR of death than low-flux semisynthetic membranes.
These data suggest that biocompatibility and permeability may impact on death and cardiovascular events in hemodialysis patients with type 2 diabetes mellitus.
透析器膜特性对发病率和死亡率的影响极具争议。
我们对德国糖尿病与透析研究的数据进行事后分析，该研究评估了高危患者使用阿托伐他汀的情况。确定了四组患者，分别持续使用高通量合成膜（n = 241）、低通量合成膜（n = 247）、低通量半合成膜（n = 119）或纤维素低通量膜（n = 41）进行透析。研究了两个终点：（1）心血管终点，包括心源性死亡、非致死性心肌梗死和中风；（2）死亡。
经过4年随访，计算了调整后的多变量相对风险（RR）。使用纤维素低通量膜（RR，2.33；95%置信区间[CI]，1.38至3.94；P = 0.002）、低通量半合成膜（RR，1.92；95% CI，1.35至2.73；P = 0.0003）或低通量合成膜（RR，1.35；95% CI，0.99至1.85；P = 0.06）透析的患者达到心血管终点的RR高于使用高通量合成透析器的患者。使用纤维素低通量膜（RR，4.14；95% CI，2.79至6.15；P < 0.0001）、低通量半合成膜（RR，2.24；95% CI，1.66至3.02；P < 0.0001）和低通量合成膜（RR，1.59；95% CI，1.22至2.07；P = 0.0006）的患者死亡可能性高于使用高通量合成膜的患者。对于低通量合成膜，使用纤维素低通量膜和低通量半合成膜的患者死亡率RR分别高出161%（RR，2.61；95% CI，1.80至3.79；P < 0.0001）和41%（RR，1.41；95% CI，1.07至1.86；P = 0.016）。使用纤维素低通量膜的患者死亡RR比低通量半合成膜高85%（RR，1.85；95% CI，1.24至2.76；P = 0.0025）。
这些数据表明，生物相容性和通透性可能会影响2型糖尿病血液透析患者的死亡和心血管事件。
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