Abe Masanori, Masakane Ikuto, Wada Atsushi, Nakai Shigeru, Nitta Kosaku, Nakamoto Hidetomo
The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
Clin Kidney J. 2021 Sep 28;15(3):473-483. doi: 10.1093/ckj/sfab177. eCollection 2022 Mar.
In Japan, dialyzers are classified based on β-microglobulin clearance. Type I dialyzers are classified as low-flux dialyzers (<10 mL/min clearance), type II and III as high-flux dialyzers (≥10 to <30 mL/min and ≥30 to <50 mL/min clearance, respectively), and type IV and V as super high-flux dialyzers (≥50 to <70 mL/min and ≥70 mL/min clearance, respectively). Super high-flux dialyzers are commonly used, but their superiority over low-flux dialyzers is controversial.
In this nationwide prospective cohort study, we analyzed Japanese Society for Dialysis Therapy Renal Data Registry data collected at the end of 2008 and 2011. We enrolled 242,467 patients on maintenance hemodialysis and divided them into five groups by dialyzer type. We assessed the associations of each dialyzer type with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis, adjusting for potential confounders.
By the end of 2011, 53,172 (21.9%) prevalent dialysis patients had died. Mortality significantly decreased according to dialyzer type. Hazard ratios (HRs) were significantly higher for type I, II and III compared with type IV (reference) after adjustment for basic factors and further adjustment for dialysis-related factors. HR was significantly higher for type I, but significantly lower for type V, after further adjustment for nutrition- and inflammation-related factors. These significant findings were also evident after propensity score matching.
Hemodialysis using super high-flux dialyzers might reduce mortality. Randomized controlled trials are warranted to clarify whether these type V dialyzers can improve prognosis.
在日本，透析器根据β-微球蛋白清除率进行分类。I型透析器被归类为低通量透析器（清除率<10 mL/分钟），II型和III型为高通量透析器（清除率分别≥10至<30 mL/分钟和≥30至<50 mL/分钟），IV型和V型为超高通量透析器（清除率分别≥50至<70 mL/分钟和≥70 mL/分钟）。超高通量透析器被广泛使用，但其相对于低通量透析器的优势存在争议。
在这项全国性前瞻性队列研究中，我们分析了2008年底和2011年底收集的日本透析治疗学会肾脏数据登记处的数据。我们纳入了242,467例维持性血液透析患者，并根据透析器类型将他们分为五组。我们使用Cox比例风险模型评估了每种透析器类型与3年全因死亡率的关联，并进行了倾向评分匹配分析，对潜在混杂因素进行了调整。
到2011年底，53,172例（21.9%）透析患者死亡。死亡率根据透析器类型显著降低。在对基本因素进行调整并进一步对透析相关因素进行调整后，I型、II型和III型的风险比（HRs）与IV型（参照）相比显著更高。在进一步对营养和炎症相关因素进行调整后，I型的HR显著更高，但V型的HR显著更低。这些显著发现在倾向评分匹配后也很明显。
使用超高通量透析器进行血液透析可能会降低死亡率。有必要进行随机对照试验以阐明这些V型透析器是否能改善预后。
