Prospective randomized study of hemodialysis membrane biocompatibility in acute renal failure

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Introduction

There is considerable controversy in the current literature as to whether HD membrane biocompatibility may influence the mortality of patients with acute renal failure (ARF). We performed a prospective randomized (central telephone randomization) study in patients with dialysis-dependent ARF treated either with Cuprophan^® (CUPRO) or polymethylmethacrylate (PMMA) low-flux membranes. The data presented are the unicentric evaluation of a larger international multicenter trial that was published recently [1].

Methods

In the study center in Berlin, a total of 104 patients were randomized. Of these, 94 patients (35f/59m) with ARF were evaluable (CUPRO 45, PMMA 49 patients). Forty-six (49%) of these were surgical/trauma patients. Mean age was 63.6 (19-87) years, mean APACHE II score was 26.3 (11-42). Sixty-seven (71%) patients required mechanical ventilation, 81 (86%) received parenteral nutrition.

Results

Overall, 56 patients (60%) survived, 25 (56%) in the CUPRO group and 31 (63%) in the PMMA group (P=n.s., Fisher's two-sided Exact Test). The odds ratio (OR) for not surviving for CUPRO vs PMMA was 1.38 with a 95% CI ranging from 0.56 to 3.42. Moreover, no difference between CUPRO and PMMA was detected when age and APACHE II score were entered as possible confounders in a logistic regression model. There was also no difference between the two study groups regarding time on dialysis, number of dialysis sessions required, need for mechanical ventilation, or total parenteral nutrition.

Conclusion

In summary, this controlled, prospective randomized trial did not reveal any differences in the outcome of dialysis-dependent ARF patients treated with CUPRO vs PMMA dialyser membranes.