June 22, 2004 - The national press is covering the release of this article in the June issue of the American Journal of Kidney Diseases (AKJD).

"High dialysis dose is associated with lower mortality among women but not among men" - abstract from AJKD.

"For people on dialysis because their kidneys have failed, death rates are lower among women when they receive a higher "dose" of dialysis. However, men do not benefit in the same way, a recent study shows.

Several studies have reported lower mortality risk among hemodialysis patients "treated with doses greater than the standard dose," Dr. Friedrich K. Port and colleagues from the University of Michigan, Ann Arbor." Story from Reuters Health.

March 12, 2004 - The April issue of Kidney International (KI) contains an analysis from the HEMO Study data that shows that increasing the dialysis dose may benefit women, but not men.

"Dialysis dose and the effect of gender and body size on outcome in the HEMO Study" - abstract from KI

November 24, 2003 - The December issue of the Journal of the American Society of Nephrology (JASN) contains a report on the findings of the HEMO Study:

"Effects of High-Flux Hemodialysis on Clinical Outcomes: Results of the HEMO Study" - abstract from JASN

An excerpt from the abstract's conclusion:

"No significant differences were observed in outcomes related to infection for either duration subgroup, however, and the trends for beneficial effects of high-flux dialysis on ACM rates were considerably weakened when the years of dialysis during the follow-up phase were combined with the prestudy years of dialysis in the analysis. For the subgroup of patients with <3.7 yr of dialysis before the study, assignment to high-flux dialysis had no significant effect on any of the examined clinical outcomes. These data suggest that high-flux dialysis might have a beneficial effect on cardiac outcomes."

January 15, 2003 - Study results from Europe seem to confirm the superiority of high-flux dialysis in terms of clinical and physiological outcomes.

"Results from EuCliD� (European Clinical Dialysis Database): Impact of shifting treatment modality" - abstract from International Journal of Artificial Organs

This paper reports that high-flux dialysis resulted in:

• a significant increase in hemoglobin
  
  
• the erythropoietin dose remained stable
  
  
• the lipid profile significantly improved
  
  
• the dry body weight and albumin levels remained stable
  
  
• the level of �2-microglobulin significantly decreased

Despite the improved clinical and physiological outcomes associated with high-flux dialysis in this paper, the HEMO Study found that patients who used high-flux filters neither lived substantially longer nor stayed out of the hospital more than those who used low-flux filters. (See December 19, 2002 story below.)

December 27, 2002 - The just-published HEMO study showed that mortality and hospitalizations are not reduced by increasing the dose of three-times-per-week hemodialysis. Attention now turns to the potential benefits of daily hemodialysis. Research will be focusing on whether three-times-per week hemodialysis is an "unphysiological" treatment that should be replaced by more frequent hemodialysis treatments.

The Canadian Medical Association (CMA) has published a document on this issue:

"Nocturnal hemodialysis: an attempt to correct the �unphysiology� of conventional intermittent renal replacement therapy" - PDF document from CMA

The current Medicare reimbursement system is based on three-times-per week hemodialysis treatments. Before this can change, the government will require proof that other treatment regimens provide superior clinical outcomes and/or economic advantages. The National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) has announced that it is accepting applications from organizations to design, develop and implement clinical treatment trials of frequent hemodialysis for patients with end stage renal disease (ESRD).

The current issue of Nephrology Dialysis Transplantation (NDT) has two full-text editorials related to more frequent home hemodialysis treatments:

• "Frequent prolonged home haemodialysis: three old concepts, one modern solution" - editorial from NDT
  
  
  
• "PHD�: the technological solution for daily haemodialysis?" - editorial from NDT

December 19, 2002 - This week's issue of the New England Journal of Medicine (NEJM) contains the results of the long-awaited HEMO study. The purpose of the HEMO Study was to identify improvements in therapy that will reduce hemodialysis mortality. The study attempted to determine whether the type of dialysis membrane used in hemodialysis or the amount of dialysis (measured by Kt/V) that is prescribed could influence well-being and survival.

Summarizing the results, patients who received a dialysis dose higher than that recommended by National Kidney Foundation (K/DOQI�) guidelines or who used high-flux filters neither lived substantially longer nor stayed out of the hospital more than those who received the currently recommended standard dose or used low-flux filters. Press release from the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases).

The HEMO Study results as published in the NEJM:

"Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis" - abstract from NEJM

Here are other news stories on the HEMO Study results:

• "More dialysis, highly permeable artificial kidney may not aid some, UT Southwestern researcher finds" - summary from EurekAlert
  
  
• "More Rigorous Dialysis Won't Boost Survival: Study" - story from Reuters Health/Yahoo. (link is no longer available)

Here is the RenalWEB Topic Page on Hemodialysis Adequacy.

May 23, 2002 - This week's issue of the Journal of the American Medical Association (JAMA) has a Medical News and Perspectives piece entitled "How to Reduce Mortality in Hemodialysis Patients Still a Puzzle". Full text article from JAMA. (link is no longer available)

The article comments on the results from the Hemodialysis (HEMO) Study, presented by lead investigator Garabed Eknoyan, MD, last month at the National Kidney Foundation's (NKF) Clinical Nephrology Meetings. The study results showed that mortality rates were basically the same for patients regardless of combinations of standard or high doses of hemodialysis and low and high dialysis membrane flux.

The HEMO study measured dialysis therapy using the Kt/V index. A number of nephrologists are now suggesting that a new index is needed for measuring dialysis therapy that will result in healthier dialysis patients.


April 24, 2002 - Lead investigator Garabed Eknoyan announced results from the landmark Hemodialysis (HEMO) Study at the National Kidney Foundation (NKF) Spring Clinical Meeting in Chicago on Sunday. The HEMO Study is the first major National Institutes of Health (NIH) clinical trial for dialysis in over 20 years.

The purpose of the HEMO Study was to identify improvements in therapy that will reduce hemodialysis mortality. The study attempted to determine whether the type of dialysis membrane used in hemodialysis or the amount of dialysis (measured by Kt/V) that is prescribed could influence well-being and survival.

Dr. Eknoyan announced that patients who received a dialysis dose higher than the minimum recommended or who used high-flux filters neither lived longer nor stayed out of the hospital longer than people who received the standard dose or used low-flux filters. Story from DG News.

One of the centers participating in the HEMO Study was the University of Alabama at Birmingham. Here is a brief explanation of the HEMO Study from the UAB web site.

Here is the NIH study guide published in 1993.


[This message has been edited by Gary Peterson (edited 06-22-2004).]