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Biocompatible membranes do not promote graft recovery following cadaveric renal transplantation

Y.M. Woo, A.-M. Craig, B.B. King, B.J.R. Junor, M.A. McMillan, J.D. Briggs and R.S.C. Rodger

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Volume 57 (2002) p. 38 - 44

Abstract

Y.M. Woo, A.-M. Craig, B.B. King, B.J.R. Junor, M.A. McMillan, J.D. Briggs and R.S.C. Rodger

¹Renal Unit, Western Infirmary, Glasgow, Scotland, and
²Renal Unit, Nelson Hospital, Nelson, New Zealand
Background: Controversy surrounds the role of biocompatible membrane dialyzers in treatment of acute renal failure. Studies that have shown a benefit have involved critically ill patients where renal recovery and patient mortality are influenced by other comorbid disease. The aim of the present work is to clarify this issue in a more homogeneous population of patients with acute renal failure following cadaveric renal transplantation. Methods: All patients with delayed graft function between January 1996 and February 1998 were randomized to receive either a biocompatible (BCM, polysulfone) membrane or bioincompatible (BICM, cuprophane) membrane for dialysis until onset of graft function. Results: Forty-one patients were randomized, 23 to receive BCM and 18 BICM. Five patients (2 BCM, 3 BICM; p = NS) with primary non-function of graft were excluded from analysis, leaving 36 cases of acute tubular necrosis (ATN). Patient and donor characteristics were similar in both groups. The BCM group had significantly longer periods of dialysis dependency compared to the BICM group (14 vs 10 days; p = 0.03). There was a tendency towards higher serum creatinine levels in the short term in the BCM group (318 vs 164 mmol/l at 1 month (p = 0.1), 190 vs 169 mmol/l at latest visit (p = 0.07)) and a greater number of acute rejection episodes in the BCM group (3.7 vs 1.7 episodes per 100 days of dialysis dependency, p = 0.1). With an intention-to-treat analysis of all 41 patients originally randomized, there was no significant difference in time to graft recovery between the 2 groups (p = 0.18). Conclusions: In the setting of ARF post-transplantation, we have found no evidence to support the use of biocompatible membranes for dialysis. Rather, our study provides argument against a large benefit for the use of BCM in the recovery of ARF, as suggested by earlier studies.

Originals

The epidemic of aging in renal replacement therapy: an update on elderly patients and their outcomes

K.J. Jager, P.C.W. van Dijk, F.W. Dekker, B. Stengel, K. Simpson and J.D. Briggs

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Volume 60 (2003) p. 352 - 360

Abstract

K.J. Jager, P.C.W. van Dijk, F.W. Dekker, B. Stengel, K. Simpson and J.D. Briggs

¹ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, ²Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands, ³Recherche Epidémiologique et Statistique sur l’Environnement et la Santé, INSERM Unité ¹⁷⁰, Villejuif cedex, France, and ⁴Scottish Renal Registry, Glasgow Royal Infirmary, Glasgow, Scotland, UK on behalf of the ERA-EDTA Registry Committee
Background: In the past 2 decades, a rapid growth has occurred in the number of patients over 65 years of age accepted for renal replacement therapy (RRT) with an increasing need for dialysis resources as a consequence. The aim of this study is to describe the trends in incidence, treatment and outcome of RRT of these elderly patients included in the new ERA-EDTA Registry database. Methods: Data from 6 national renal registries have been included for the period 1985 – 1999, comprising data of 18,920 elderly patients starting RRT. We used Cox-proportional hazards regression to predict patient and technique survival. Results: The incidence and prevalence of RRT showed a 4- to 5-fold increase over the period, resulting in 48% of the new patients being older than 65 years in 1999. However, the rates varied considerably between countries. The 2-year patient survival was 51% in dialysis patients. Mortality due to social causes increased with age. Multivariate analysis showed no change with time in patient survival on dialysis, but the risk of death following a first renal allograft between 1995 and 1999 was reduced by 31%, compared with the 1985 – 1989 time period (RR 0.69; 95% CI: 0.54 – 0.90). The relative risk of peritoneal dialysis technique failure was more than doubled in the 1995 – 1999 cohort compared to the 1985 – 1989 cohort (RR 2.38; 95% CI: 1.89 – 3.01), with the highest technique failure rate in the first 2 years of the 1995 – 1999 cohort. Conclusions: The number of elderly patients receiving RRT is rising rapidly. Patient survival on dialysis has been stable over the last 15 years, whereas transplant outcome has improved. The increased peritoneal dialysis technique failure and the high mortality due to social causes in the elderly age groups require further investigation. The challenge of the years ahead is to provide this life-prolonging therapy to all patients who need it in such a way that it improves quality of life and at a cost that a society can afford.

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