Effects of low-flux and high-flux hemodialysis on the survival of elderly maintenance hemodialysis patients

Abstract

Background

Elderly hemodialysis (HD) patients have a high risk of death. The effect of different types of HD membranes on survival is still controversial. The purpose of this study was to determine the relationship between the use of low-flux or high-flux membranes and all-cause and cardiovascular mortality in elderly hemodialysis patients.

Methods

This was a retrospective clinical study involving maintenance hemodialysis patients which were categorized into low-flux and high-flux groups according to the dialyzer they were using. Propensity score matching was used to balance the baseline data of the two groups. Survival rates were compared between the two groups, and the risk factors for death were analyzed by multivariate Cox regression.

Results

Kaplan–Meier survival analysis revealed no significant difference in all-cause mortality between the low-flux group and the high-flux group (log-rank test, p = 0.559). Cardiovascular mortality was significantly greater in the low-flux group than in the high-flux group (log-rank test, p = 0.049). After adjustment through three different multivariate models, we detected no significant difference in all-cause mortality. Patients in the high-flux group had a lower risk of cardiovascular death than did those in the low-flux group (HR = 0.79, 95% CI, 0.54–1.16, p = 0.222; HR = 0.58, 95% CI, 0.37–0.91, p = 0.019).

Conclusions

High-flux hemodialysis was associated with a lower relative risk of cardiovascular mortality in elderly MHD patients. High-flux hemodialysis did not improve all-cause mortality rate. Differences in urea distribution volume, blood flow, and systemic differences in solute clearance by dialyzers were not further analyzed, which are the limitations of this study.

Keywords:

• High-flux
• low-flux
• hemodialysis
• elderly
• survival

Acknowledgments

We thank all the doctors and patients who provided the data to support this study.

Authors’ contributions

All the authors contributed to the study conception and design. Data collection and analysis were performed by Ning Cao, Jiuxu Bai, Wanqing Huang, Yanping Zhang, Dongxia Qiu, Lin Wei, Kaiming Ren, Qian Wang, Chen Zhao and Zhuo Ren. The first draft of the manuscript was written by Wanqing Huang and Jiuxu Bai. All the authors commented on previous versions of the manuscript. All the authors have read and approved the final manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the General Hospital of Northern Theater Command (approval number Y (2023) 152).

Consent form

Written consent was not needed because of the retrospective nature of the study.

Disclosure statement

No potential conflicts of interest were reported by the authors.

Data availability statement

The datasets used in this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the Liaoning Provincial Science and Technology Plan Joint Fund (2023-MSLH-350).