Krane V et al. (2007) Dialyzer membrane characteristics and outcome of patients with type 2 diabetes on maintenance hemodialysis. Am J Kidney Dis 49: 267–275

Diabetes mellitus considerably increases the mortality rate among maintenance hemodialysis patients. Whether the biocompatibility and flux characteristics of the dialysis membrane influence cardiovascular event and mortality rates in this high-risk population is unclear. Using data from the German Diabetes and Dialysis (4D) Study, Krane et al. conducted a post hoc analysis of the relationship between dialysis membrane permeability and biocompatibility, and outcomes of 648 patients with diabetes mellitus. The study population was divided into four groups on the basis of dialysis membrane class: low-flux cellulosic (n = 41); low-flux semisynthetic (n = 119); low-flux synthetic (n = 247); and high-flux synthetic (n = 241).

Greater membrane permeability was associated with lower all-cause mortality. Those patients dialyzed via high-flux membranes had a 3-year cumulative incidence of death from all causes of 33%, compared with 84%, 56% and 65% for patients dialyzed using low-flux cellulosic, low-flux synthetic, and low-flux semisynthetic membranes, respectively. With regard to biocompatibility, the risk of all-cause mortality was 161% greater in patients using low-flux cellulosic membranes and 41% greater in patients using low-flux semisynthetic membranes than in patients using low-flux synthetic membranes. The risk of reaching a composite cardiovascular end point was also higher for patients dialyzed via a cellulosic or semisynthetic membrane than for those dialyzed with the more biocompatible synthetic membrane.

These data suggest that dialyzer membrane biocompatibility and permeability might impact on the outcome of long-term hemodialysis patients with diabetes.