Cellulose, modified cellulose and synthetic membranes in the haemodialysis of patients with end-stage renal disease

Cochrane Renal Group

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background When the kidney fails the blood-borne metabolites of protein breakdown and water cannot be excreted. The principle of haemodialysis is that such substances can be removed when blood is passed over a semipermeable membrane. Natural membrane materials include cellulose or modified cellulose, more recently various synthetic membranes have been developed. Synthetic membranes are regarded as being more "biocompatible" in that they incite less of an immune response than cellulose-based membranes.

Objectives To assess the effects of different haemodialysis membrane material in patients with end-stage renal disease (ESRD).

Search strategy We searched MEDLINE, EMBASE, PreMEDLINE, HealthStar CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Biosis, SIGLE, CRIB, UK National Research Register and reference lists of relevant articles. We contacted biomedical companies, known investigators and handsearched selected journals and conference proceedings. Date of most recent search: June 2004.

Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs comparing different haemodialysis membrane material in patients with ESRD.

Data collection and analysis Two reviewers independently assessed the methodological quality of studies. Data was abstracted onto a standard form by one reviewer and checked by another. Relative Risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI))

Main results Thirty two studies were identified. Pre-dialysis beta(2) microglobulin concentrations were not significantly lower in patients treated with synthetic membranes (WMD-14.67, 95% CI-33.10 to 4.05). When analysed for change in beta(2) microglobulin, a fall was only noted with high-flux membranes. The incidence of amyloid was less in patients who were dialysed for six years with high-flux synthetic membranes (one study, RR 0.03, 95% CI 0.00 to 0.54). There was a significant difference in favour of the synthetic (high-flux) membrane in comparison to cellulose membranes for triglycerides (WMD- 0.66;95% CI-1.18 to -0.14) but not for modified cellulose membranes. Dialysis adequacy measured by Kt/V was marginally higher when cellulose membranes were used (WMD- 0.10;95% CI-0.16 to 0.04), whereas synthetic membranes achieved significantly higher Kt/V values when compared with modified cellulose membranes (WMD 0.20, 95% 0.11 to 0.29). There were no data on quality of life measures.

Authors' conclusions We found no evidence of benefit when synthetic membranes were compared with cellulose/modified cellulose membranes in terms of reduced mortality no reduction in dialysis-related adverse symptoms. Despite the relatively large number of RCTs undertaken in this area none of the included studies reported any measures of quality of life.

Original languageEnglish
Pages (from-to)CD003234
Number of pages65
JournalCochrane Database of Systematic Reviews
Issue number3
Early online date20 Jul 2005
DOIs
Publication statusPublished - 2009

Fingerprint

Cellulose
Chronic Kidney Failure
Renal Dialysis
Membranes
Confidence Intervals
beta 2-Microglobulin
Dialysis
Randomized Controlled Trials
Quality of Life
Amyloid
MEDLINE
Patient Selection

Keywords

  • cellulose
  • humans
  • kidney failure, chronic
  • membranes, artificial
  • outcome assessment (health care)
  • randomized controlled trials as topic
  • renal dialysis
  • beta 2-microglobulin
  • platelet activation
  • high-flux dialysis
  • blood mononuclear-cells
  • C-reactive protein
  • oxidative stress
  • dialyzer membrane
  • bicarbonate hemodialysis
  • biocompatible membrane
  • nutritional parameters
  • complement activation

Cite this

Cellulose, modified cellulose and synthetic membranes in the haemodialysis of patients with end-stage renal disease. / Cochrane Renal Group.

In: Cochrane Database of Systematic Reviews, No. 3, 2009, p. CD003234.

Research output: Contribution to journalArticle

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TY - JOUR

T1 - Cellulose, modified cellulose and synthetic membranes in the haemodialysis of patients with end-stage renal disease

AU - MacLeod, A M

AU - Campbell, M K

AU - Cody, J D

AU - Daly, C

AU - Grant, A

AU - Khan, I

AU - Rabindranath, K S

AU - Vale, L

AU - Wallace, S A

AU - Cochrane Renal Group

PY - 2009

Y1 - 2009

N2 - Background When the kidney fails the blood-borne metabolites of protein breakdown and water cannot be excreted. The principle of haemodialysis is that such substances can be removed when blood is passed over a semipermeable membrane. Natural membrane materials include cellulose or modified cellulose, more recently various synthetic membranes have been developed. Synthetic membranes are regarded as being more "biocompatible" in that they incite less of an immune response than cellulose-based membranes.Objectives To assess the effects of different haemodialysis membrane material in patients with end-stage renal disease (ESRD).Search strategy We searched MEDLINE, EMBASE, PreMEDLINE, HealthStar CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Biosis, SIGLE, CRIB, UK National Research Register and reference lists of relevant articles. We contacted biomedical companies, known investigators and handsearched selected journals and conference proceedings. Date of most recent search: June 2004.Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs comparing different haemodialysis membrane material in patients with ESRD.Data collection and analysis Two reviewers independently assessed the methodological quality of studies. Data was abstracted onto a standard form by one reviewer and checked by another. Relative Risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI))Main results Thirty two studies were identified. Pre-dialysis beta(2) microglobulin concentrations were not significantly lower in patients treated with synthetic membranes (WMD-14.67, 95% CI-33.10 to 4.05). When analysed for change in beta(2) microglobulin, a fall was only noted with high-flux membranes. The incidence of amyloid was less in patients who were dialysed for six years with high-flux synthetic membranes (one study, RR 0.03, 95% CI 0.00 to 0.54). There was a significant difference in favour of the synthetic (high-flux) membrane in comparison to cellulose membranes for triglycerides (WMD- 0.66;95% CI-1.18 to -0.14) but not for modified cellulose membranes. Dialysis adequacy measured by Kt/V was marginally higher when cellulose membranes were used (WMD- 0.10;95% CI-0.16 to 0.04), whereas synthetic membranes achieved significantly higher Kt/V values when compared with modified cellulose membranes (WMD 0.20, 95% 0.11 to 0.29). There were no data on quality of life measures.Authors' conclusions We found no evidence of benefit when synthetic membranes were compared with cellulose/modified cellulose membranes in terms of reduced mortality no reduction in dialysis-related adverse symptoms. Despite the relatively large number of RCTs undertaken in this area none of the included studies reported any measures of quality of life.

AB - Background When the kidney fails the blood-borne metabolites of protein breakdown and water cannot be excreted. The principle of haemodialysis is that such substances can be removed when blood is passed over a semipermeable membrane. Natural membrane materials include cellulose or modified cellulose, more recently various synthetic membranes have been developed. Synthetic membranes are regarded as being more "biocompatible" in that they incite less of an immune response than cellulose-based membranes.Objectives To assess the effects of different haemodialysis membrane material in patients with end-stage renal disease (ESRD).Search strategy We searched MEDLINE, EMBASE, PreMEDLINE, HealthStar CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Biosis, SIGLE, CRIB, UK National Research Register and reference lists of relevant articles. We contacted biomedical companies, known investigators and handsearched selected journals and conference proceedings. Date of most recent search: June 2004.Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs comparing different haemodialysis membrane material in patients with ESRD.Data collection and analysis Two reviewers independently assessed the methodological quality of studies. Data was abstracted onto a standard form by one reviewer and checked by another. Relative Risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI))Main results Thirty two studies were identified. Pre-dialysis beta(2) microglobulin concentrations were not significantly lower in patients treated with synthetic membranes (WMD-14.67, 95% CI-33.10 to 4.05). When analysed for change in beta(2) microglobulin, a fall was only noted with high-flux membranes. The incidence of amyloid was less in patients who were dialysed for six years with high-flux synthetic membranes (one study, RR 0.03, 95% CI 0.00 to 0.54). There was a significant difference in favour of the synthetic (high-flux) membrane in comparison to cellulose membranes for triglycerides (WMD- 0.66;95% CI-1.18 to -0.14) but not for modified cellulose membranes. Dialysis adequacy measured by Kt/V was marginally higher when cellulose membranes were used (WMD- 0.10;95% CI-0.16 to 0.04), whereas synthetic membranes achieved significantly higher Kt/V values when compared with modified cellulose membranes (WMD 0.20, 95% 0.11 to 0.29). There were no data on quality of life measures.Authors' conclusions We found no evidence of benefit when synthetic membranes were compared with cellulose/modified cellulose membranes in terms of reduced mortality no reduction in dialysis-related adverse symptoms. Despite the relatively large number of RCTs undertaken in this area none of the included studies reported any measures of quality of life.

KW - cellulose

KW - humans

KW - kidney failure, chronic

KW - membranes, artificial

KW - outcome assessment (health care)

KW - randomized controlled trials as topic

KW - renal dialysis

KW - beta 2-microglobulin

KW - platelet activation

KW - high-flux dialysis

KW - blood mononuclear-cells

KW - C-reactive protein

KW - oxidative stress

KW - dialyzer membrane

KW - bicarbonate hemodialysis

KW - biocompatible membrane

KW - nutritional parameters

KW - complement activation

U2 - 10.1002/14651858.CD003234.pub2

DO - 10.1002/14651858.CD003234.pub2

M3 - Article

SP - CD003234

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 3

ER -