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Dialysis (HD/PD)

Dialysis (HD/PD). The HEMO Study. Hemodialysis (HEMO) Study. Reference Rocco MV. The HEMO study: applicability and generalizability. Nephrol Dial Transplant. 2005;20:278–284. Background

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Dialysis (HD/PD)

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  1. Dialysis (HD/PD) The HEMO Study Hemodialysis (HEMO) Study Reference Rocco MV. The HEMO study: applicability and generalizability. Nephrol Dial Transplant. 2005;20:278–284.

  2. Background Increased levels of high-sensitivity C-reactive protein are a predictor of cardiovascular diseases. Statin therapy reduces the high-sensitivity C-reactivity protein levels in healthy patients and in patients with stable coronary disease. So the hypothesis was made that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin therapy.

  3. Aim To determine whether further increases in dialysis dose above current standards or the use of high-flux membranes would improve patient outcomes

  4. Method Study design: The HEMO study was a randomized, multicenter, prospective, 2x2 factorial clinical trial. Study population: A total of 5200 patients were included in this study under the recruitto-replace strategy. Post-randomization, the patients who died, terminated hemodialysis due to kidney transplantation, and switched to another type of dialysis facility were replaced with newly randomized patients. The actual mean follow-up time was 2.84 years due to the high death rate of chronic hemodialysis patient. Criteria for inclusion was a residual kidney urea clearance of ≤1.5 mL/min per 35 L of urea distribution volume and achievement of a Kt/V >1.3 in 2–3 consecutive monitored sessions in which the high dose was targeted and serum albumin >2.6 g/dL by nephelometry.

  5. Dosage regimen: 1846 patients were randomized to either a high dose (with target urea equilibrated Kt/V of 1.45) or a standard dose (with a target Kt/V of 1.05) of dialysis and to a high flux (mean b2-microglobulin clearance of >20 mL/min) or low-flux (mean b2-microglobulin clearance of >10 mL/min) membrane. End point: Death from any cause was the primary outcome of the HEMO study.

  6. Results No significant interaction was seen between the flux and dose interventions for the primary outcome which was mortality. Neither the dose nor the flux intervention effect varied depending on the level of the other intervention. This was an indication that there was no evidence.

  7. Conclusion The HEMO study supports the current clinical practice guidelines for dialysis three times a week. However, the results do not support the conventional attempts to reduce the high morbidity and mortality in hemodialysis patients. The HEMO study reiterates the current clinical practice of three times dialysis per week. The results, however, not support conventional attempts in reducing the high morbidity and mortality in hemodialysis patients.

  8. Conclusion In patients with type 2 diabetes on maintenance hemodialysis, routine statin treatment does not reduce the primary end point of death from cardiac causes, myocardial infarction or stroke. The routine statin treatment in patients with type 2 diabetes on maintenance hemodialysis has not reduce the death from cardiac causes, MI or stroke.

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