How Will the Results of the HEMO Study Impact Dialysis Practice

摘要: Uremia is the clinical consequence of poor renal function and also target hemodialysis (HD) therapy. In absence a comprehensive understanding uremia, optimum therapy for an average patient with end-stage disease (ESRD) can be discovered by observing outcomes during large trial randomly assigned dialysis options. The HEMO study was ambitious effort to bypass traditional studies pathogenesis (uremia) in favor this type population (1). motivation embarking upon like has been persistently high HD mortality rate United States over past 15 years (2). Most trials are tests drug therapies where primary goal determine whether or not question works, that is, treatment better than placebo. contrast, investigators were hoping response, but had true equipoise, meaning they equally willing accept negative positive response. statistical terms, reject null hypothesis, which case dose and/or membrane flux would have effect. Potential benefits could realized either outcome, so ‘‘failure’’ such only occurs when outcome equivocal, perhaps suggesting effect no definite conclusion. results viewed all participants, patients, investigators, industry, public general as resounding success. clearly demonstrated futility recent popular attempts push beyond Dialysis Outcomes Quality Initiative (DOQI) recommended minimum limit. Prior study, targeted dose, expressed single-pool Kt/V 1.30 per administered three times week, derived from consensus practicing nephrologists (3). Now, addition learned opinion nephrologists, provides objective evidence previously established (4). addition, shows us improving clearance molecules (independent small molecules) using high-flux membranes does improve survival patient. Both these observations far-reaching implications regard uremia its treatment. Applicability Study