Research Updates in Kidney and Urologic Health

NIDDK Study Confirms Recommended Dialysis Dose

No Advantage for Increased Kt/V or High Flux

The first major National Institutes of Health clinical trial for dialysis in more than 20 years confirms that the minimum dose recommended by treatment guidelines is adequate and that, in general, a higher dose and special filters provide no added benefit to patients. High death rates and frequent hospitalizations among hemodialysis patients were the major impetus for the landmark Hemodialysis (HEMO) Study, which was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

People who received a dialysis dose higher than the recommended minimum or who used high-flux filters neither lived longer nor stayed out of the hospital more than people who received the standard dose or used low-flux filters, announced lead HEMO Study investigator Garabed Eknoyan, M.D., at a National Kidney Foundation (NKF) meeting in Chicago in April 2002. This will be welcome news to the hundreds of thousands of people in the United States who undergo hemodialysis. The results support clinical practice guidelines from NKF's Kidney Disease Outcomes Quality Initiative (K/DOQI).

The HEMO Study tested the theory that high-flux filters and a higher dialysis dose might keep patients healthier and stem rising hospitalizations, deaths, and costs. Doctors at 15 medical centers recruited more than 1,800 patients who agreed to be randomly assigned to high or standard dialysis doses and high- or low-flux filters. Death was the major focus of the study, but factors such as frequency of hospitalization, nutritional status, and quality of life were also assessed.

While the HEMO Study showed that neither more dialysis nor high-flux filters reduced hospitalizations or deaths among trial participants as a whole, findings for certain groups of patients are intriguing. The higher dialysis dose appeared to reduce the risk of death and hospitalization among women, and the high-flux filter appeared to reduce the risk of death among people who had been on hemodialysis for longer than 3½ years when they entered the study. But these issues need further study before conclusions can be drawn, cautioned Dr. Eknoyan, professor of medicine at Baylor College of Medicine in Houston.

Kidney failure is a growing problem. More people are being diagnosed each year, adding to rising medical costs that strain an already stressed system. In the United States, more than 340,000 people are on dialysis or have a kidney transplant, and costs have reached $17 billion a year. Death rates from kidney failure in the United States are among the highest in the world with nearly 25 percent of those on hemodialysis dying each year.

NIDDK has begun a program to reduce the number of people developing kidney failure, and researchers continue to search for better treatments. Kidney failure can be prevented or slowed, but only a fraction of people who are at high risk are screened or managed appropriately. The National Kidney Disease Education Program will seek to raise awareness about the seriousness of kidney disease and its complications and about the importance of prevention, as well as the importance of early diagnosis and appropriate management to ensure better futures for those whose kidneys do fail.

Baxter Healthcare Corporation, Fresenius USA Inc., R&D Laboratories Inc., and Ross Products Division of Abbott Laboratories Inc. donated products for the HEMO Study.

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