Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study
Abstract Background Survival is equivalent between super high-flux hemodialysis (SHF-HD) and online hemodiafiltration (OHDF) with similar albumin leakage. According to the 2013 Japanese dialyzer performance classification, survival on HD is optimal when a type II dialyzer (β2-microglobulin clearance...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Renal Replacement Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41100-023-00490-3 |
| _version_ | 1797784447213371392 |
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| author | Kazuyoshi Okada Manabu Tashiro Hiroyuki Michiwaki Tomoko Inoue Hisato Shima Jun Minakuchi Shu Kawashima |
| author_facet | Kazuyoshi Okada Manabu Tashiro Hiroyuki Michiwaki Tomoko Inoue Hisato Shima Jun Minakuchi Shu Kawashima |
| author_sort | Kazuyoshi Okada |
| collection | DOAJ |
| description | Abstract Background Survival is equivalent between super high-flux hemodialysis (SHF-HD) and online hemodiafiltration (OHDF) with similar albumin leakage. According to the 2013 Japanese dialyzer performance classification, survival on HD is optimal when a type II dialyzer (β2-microglobulin clearance ≥ 70 mL/min) is used. Here, we investigated whether survival could be improved by SHF-HD using a type II-b dialyzer (sieving coefficient for albumin ≥ 0.03) with high albumin leakage compared with OHDF or SHF-HD using a type II-a dialyzer (sieving coefficient for albumin < 0.03) with low albumin leakage. Methods This 3-year retrospective observational propensity score-matched study included 738 patients receiving SHF-HD (n = 310) or OHDF (n = 428) with a type II dialyzer at our institution between April 1 and July 1, 2017. Three-year all-cause mortality was compared for SHF-HD with high estimated albumin leakage (EAL) versus OHDF and SHF-HD with low EAL. Kaplan–Meier survival curves were compared using the log-rank test and hazard ratios were calculated by Cox regression analysis. Results Mortality in SHF-HD with high EAL was significantly lower than OHDF with low EAL (each n = 52 after matching; P = 0.007, log-rank test). All the dialyzers used a polyethersulfone (PES) membrane, whereas none of the hemodiafilters had a PES membrane. In SHF-HD, mortality was significantly lower when EAL was ≥ 3.0 g/session than when EAL was < 3.0 g/session (each n = 115 after matching, P = 0.004, log-rank test) and when the dialyzer used was type II-b rather than type II-a (each n = 133 after matching, P = 0.001, log-rank test). Conclusions These findings suggest that survival is better on SHF-HD using a type II-b dialyzer with high albumin leakage than on OHDF with low albumin leakage or SHF-HD using a type II-a dialyzers. The PES used in the type II-b dialyzer may also have a beneficial effect on survival. |
| first_indexed | 2024-03-13T00:40:00Z |
| format | Article |
| id | doaj.art-bd0dcc935c6543ed9f6b3fd2c163137e |
| institution | Directory Open Access Journal |
| issn | 2059-1381 |
| language | English |
| last_indexed | 2024-03-13T00:40:00Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj.art-bd0dcc935c6543ed9f6b3fd2c163137e2023-07-09T11:25:35ZengBMCRenal Replacement Therapy2059-13812023-07-019111010.1186/s41100-023-00490-3Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB studyKazuyoshi Okada0Manabu Tashiro1Hiroyuki Michiwaki2Tomoko Inoue3Hisato Shima4Jun Minakuchi5Shu Kawashima6Department of Nephrology, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalDepartment of Clinical Engineering, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalDepartment of Nephrology, Kawashima HospitalAbstract Background Survival is equivalent between super high-flux hemodialysis (SHF-HD) and online hemodiafiltration (OHDF) with similar albumin leakage. According to the 2013 Japanese dialyzer performance classification, survival on HD is optimal when a type II dialyzer (β2-microglobulin clearance ≥ 70 mL/min) is used. Here, we investigated whether survival could be improved by SHF-HD using a type II-b dialyzer (sieving coefficient for albumin ≥ 0.03) with high albumin leakage compared with OHDF or SHF-HD using a type II-a dialyzer (sieving coefficient for albumin < 0.03) with low albumin leakage. Methods This 3-year retrospective observational propensity score-matched study included 738 patients receiving SHF-HD (n = 310) or OHDF (n = 428) with a type II dialyzer at our institution between April 1 and July 1, 2017. Three-year all-cause mortality was compared for SHF-HD with high estimated albumin leakage (EAL) versus OHDF and SHF-HD with low EAL. Kaplan–Meier survival curves were compared using the log-rank test and hazard ratios were calculated by Cox regression analysis. Results Mortality in SHF-HD with high EAL was significantly lower than OHDF with low EAL (each n = 52 after matching; P = 0.007, log-rank test). All the dialyzers used a polyethersulfone (PES) membrane, whereas none of the hemodiafilters had a PES membrane. In SHF-HD, mortality was significantly lower when EAL was ≥ 3.0 g/session than when EAL was < 3.0 g/session (each n = 115 after matching, P = 0.004, log-rank test) and when the dialyzer used was type II-b rather than type II-a (each n = 133 after matching, P = 0.001, log-rank test). Conclusions These findings suggest that survival is better on SHF-HD using a type II-b dialyzer with high albumin leakage than on OHDF with low albumin leakage or SHF-HD using a type II-a dialyzers. The PES used in the type II-b dialyzer may also have a beneficial effect on survival.https://doi.org/10.1186/s41100-023-00490-3Albumin leakageSuper high-fluxHemodialysisOnline hemodiafiltrationPolyethersulfone |
| spellingShingle | Kazuyoshi Okada Manabu Tashiro Hiroyuki Michiwaki Tomoko Inoue Hisato Shima Jun Minakuchi Shu Kawashima Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study Renal Replacement Therapy Albumin leakage Super high-flux Hemodialysis Online hemodiafiltration Polyethersulfone |
| title | Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study |
| title_full | Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study |
| title_fullStr | Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study |
| title_full_unstemmed | Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study |
| title_short | Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study |
| title_sort | comparison of survival for super high flux hemodialysis shf hd with high albumin leakage versus online hemodiafiltration or shf hd with low albumin leakage the superb study |
| topic | Albumin leakage Super high-flux Hemodialysis Online hemodiafiltration Polyethersulfone |
| url | https://doi.org/10.1186/s41100-023-00490-3 |
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