Impact of dialysis dose and membrane on infection-related hospitalization and death

Results of the HEMO study

Michael Allon, Thomas A. Depner, Milena Radeva, James Bailey, Srinivasan Beddhu, David Butterly, Daniel W. Coyne, Jennifer J. Gassman, Allen M. Kaufman, George Kaysen, Julia A. Lewis, Steve J. Schwab

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

Infection is the second most common cause of death among hemodialysis patients. A predefined secondary aim of the HEMO study was to determine if dialysis dose or flux reduced infection-related deaths or hospitalizations. The effects of dialysis dose, dialysis membrane, and other clinical parameters on infection-related deaths and first infection-related hospitalizations were analyzed using Cox regression analysis. Among the 1846 randomized patients (mean age, 58 yr; 56% female; 63% black; 45% with diabetes), there were 871 deaths, of which 201 (23%) were due to infection. There were 1698 infection-related hospitalizations, yielding a 35% annual rate. The likelihood of infection-related death did not differ between patients randomized to a high or standard dose (relative risk [RR], 0.99 [0.75 to 1.31]) or between patients randomized to high-flux or low-flux membranes (RR, 0.85 [0.64 to 1.13]). The relative risk of infection-related death was associated (P < 0.001 for each variable) with age (RR, 1.47 [1.29 to 1.68] per 10 yr); co-morbidity score (RR, 1.46 [1.21 to 1.76]), and serum albumin (RR, 0.19 [0.09 to 0.41] per g/dl). The first infection-related hospitalization was related to the vascular access in 21% of the cases, and non-access-related in 79%. Catheters were present in 32% of all study patients admitted with access-related infection, even though catheters represented only 7.6% of vascular accesses in the study. In conclusion, infection accounted for almost one fourth of deaths. Infection-related deaths were not reduced by higher dose or by high flux dialyzers. In this prospective study, most infection-related hospitalizations were not attributed to vascular access. However, the frequency of access-related, infection-related hospitalizations was disproportionately higher among patients with catheters compared with grafts or fistulas.

Original languageEnglish (US)
Pages (from-to)1863-1870
Number of pages8
JournalJournal of the American Society of Nephrology
Volume14
Issue number7
DOIs
StatePublished - Jul 1 2003

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Dialysis
Hospitalization
Membranes
Infection
Blood Vessels
Catheters
Catheter-Related Infections
Serum Albumin
Fistula
Renal Dialysis
Cause of Death
Regression Analysis
Prospective Studies
Morbidity
Transplants

ASJC Scopus subject areas

  • Nephrology

Cite this

Impact of dialysis dose and membrane on infection-related hospitalization and death : Results of the HEMO study. / Allon, Michael; Depner, Thomas A.; Radeva, Milena; Bailey, James; Beddhu, Srinivasan; Butterly, David; Coyne, Daniel W.; Gassman, Jennifer J.; Kaufman, Allen M.; Kaysen, George; Lewis, Julia A.; Schwab, Steve J.

In: Journal of the American Society of Nephrology, Vol. 14, No. 7, 01.07.2003, p. 1863-1870.

Research output: Contribution to journalArticle

Allon, M, Depner, TA, Radeva, M, Bailey, J, Beddhu, S, Butterly, D, Coyne, DW, Gassman, JJ, Kaufman, AM, Kaysen, G, Lewis, JA & Schwab, SJ 2003, 'Impact of dialysis dose and membrane on infection-related hospitalization and death: Results of the HEMO study', Journal of the American Society of Nephrology, vol. 14, no. 7, pp. 1863-1870. https://doi.org/10.1097/01.ASN.0000074237.78764.D1
Allon, Michael ; Depner, Thomas A. ; Radeva, Milena ; Bailey, James ; Beddhu, Srinivasan ; Butterly, David ; Coyne, Daniel W. ; Gassman, Jennifer J. ; Kaufman, Allen M. ; Kaysen, George ; Lewis, Julia A. ; Schwab, Steve J. / Impact of dialysis dose and membrane on infection-related hospitalization and death : Results of the HEMO study. In: Journal of the American Society of Nephrology. 2003 ; Vol. 14, No. 7. pp. 1863-1870.
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abstract = "Infection is the second most common cause of death among hemodialysis patients. A predefined secondary aim of the HEMO study was to determine if dialysis dose or flux reduced infection-related deaths or hospitalizations. The effects of dialysis dose, dialysis membrane, and other clinical parameters on infection-related deaths and first infection-related hospitalizations were analyzed using Cox regression analysis. Among the 1846 randomized patients (mean age, 58 yr; 56{\%} female; 63{\%} black; 45{\%} with diabetes), there were 871 deaths, of which 201 (23{\%}) were due to infection. There were 1698 infection-related hospitalizations, yielding a 35{\%} annual rate. The likelihood of infection-related death did not differ between patients randomized to a high or standard dose (relative risk [RR], 0.99 [0.75 to 1.31]) or between patients randomized to high-flux or low-flux membranes (RR, 0.85 [0.64 to 1.13]). The relative risk of infection-related death was associated (P < 0.001 for each variable) with age (RR, 1.47 [1.29 to 1.68] per 10 yr); co-morbidity score (RR, 1.46 [1.21 to 1.76]), and serum albumin (RR, 0.19 [0.09 to 0.41] per g/dl). The first infection-related hospitalization was related to the vascular access in 21{\%} of the cases, and non-access-related in 79{\%}. Catheters were present in 32{\%} of all study patients admitted with access-related infection, even though catheters represented only 7.6{\%} of vascular accesses in the study. In conclusion, infection accounted for almost one fourth of deaths. Infection-related deaths were not reduced by higher dose or by high flux dialyzers. In this prospective study, most infection-related hospitalizations were not attributed to vascular access. However, the frequency of access-related, infection-related hospitalizations was disproportionately higher among patients with catheters compared with grafts or fistulas.",
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