More Dialysis Doesn't Improve Survival of Kidney Patients

A large multicenter study of 1,850 patients with end-stage kidney disease (ESKD) has found that contrary to expectations, longer dialysis treatment and use of a highly permeable artificial kidney do not improve survival rates or reduce hospitalization. The results were reported in the December 19, 2003, issue of The New England Journal of Medicine.

These outcomes conflict with previous studies that reported improvements in morbidity and mortality in patients treated with a higher dose of dialysis or a more permeable membrane. However, the new study did show some benefit for selected subgroups. Deaths and hospitalization from heart disease were significantly lower in those patients treated with the more permeable membrane, and the mortality rate of women receiving higher doses of dialysis was 19% lower than that of women receiving the standard dose. In about 60% of ESKD patients, the cause of death is heart disease or stroke.

"We learned a higher dose of dialysis and a higher permeable membrane are not enough,” said Dr. Robert Toto, senior author and professor of internal medicine at the University of Texas Southwestern Medical Center (Dallas, USA; www.swmed.edu). "We've got to do better. We've got to do more to help improve the quality and duration of life of patients on hemodialysis.” The UT Southwestern Medical Center was one of the participating centers in the study.




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