Kessler M, Hoen B, Paul-Dauphin A, Hestin D, for the
Cooperative Group on Bacterial Infection in HD
Lack of association between dialysis membrane biocompatibility
and bacteremia in chronic hemodialysis patients. Multicenter
prospective study
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1487 1996
Bioincompatible dialysis membranes have been associated with
complement activation and impairment of several aspects of the immune
response (Hakim, Kidney Int, 1993). Whether or not these changes
contribute to the high incidence of infection among hemodialysis
patients is still unresolved (Daugirdas, Nephrol Dial Transplant,
1994). Kessler and collegues from the University Hospital, Nancy,
France, conducted a prospective multicenter study to determine the
incidence and risk factors for bacteremia in chronic hemodialysis
patients. In this abstract they report their results and analyze the
effect of membrane bioincompatibility on the incidence of bacteremia.
988 adults receiving hemodialysis for one month or longer were
followed up for 6 months. There were 50 episodes of bacteremia
(incidence of 0.93 episodes per 100 patient-months). Of the 19
variables examined, vascular access (catheter vs fistula), previous
history of bacteremia, current immunosupressive therapy, and decreased
corpuscular hemoglobin were identified as significant and independent
risk factors by Multivariate Cox analysis. Neither type of dialysis
membrane nor staphylococcal nasal carriage was significantly
associated with the occurrence of bacteremia. 54% of bacteremic
patients were on biocompatible synthetic dialyzers compared to 57.6%
of non-bacteremic patients.
Comment: This study suggests that membrane bioincompatibility
does not significantly contribute to the risk of bacteremia in chronic
hemodialysis patients. Although the authors controlled for factors
such as Kt/V, serum albumin, and erythropoietin by multivariate
analysis, the effect of membrane bioincompatibility is subject to many
biases that are best controlled in a randomized trial. The reported
lack of association should be interpreted with caution in the absence
of dialyzer reuse information. Reuse of unsubstituted cellulosic
membranes has been associated with less complement activation (Zaoui,
Kidney Int, 1991), which could potentially offset the
bioincompatibility effect. Although low rates of reuse were reported
by the same authors in a previous paper (Hoen, Nephrol Dial
Transplant, 1995), this information is lacking in the present
abstract. Consequently, the negative results of this study should be
interpreted with caution. (Gregorio T. Obrador, M.D. and Brian
J.G. Pereira, M.D., D.M., New England Medical Center, Boston, MA)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
Am Soc Nephrol
Basic hemodialysis :
Dialyzers
CRF by problem area :
Infections (other than hepatitis, peritonitis)