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. 2005 Jul 20;2005(3):CD003234.
doi: 10.1002/14651858.CD003234.pub2.

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

A M Macleod  1 , M Campbell, J D Cody, C Daly, C Donaldson, A Grant, I Khan, K S Rabindranath, L Vale, S Wallace
Affiliations

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

A M Macleod et al. Cochrane Database Syst Rev. .

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 ss(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 ss(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.

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Conflict of interest statement

A MacLeod was the chairperson of the Standards and Audit Subcommittee of the Renal Association (UK) during work on the original version of this review.

Figures

1.1
1.1. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 1 Sessions with symptomatic hypotension.
1.2
1.2. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 2 VLDL cholesterol level (mmol/L).
1.8
1.8. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 8 Patients with episode of infection.
1.10
1.10. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 10 Hospital admissions/patient/year.
1.11
1.11. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 11 Days in hospital/patient/year.
1.12
1.12. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 12 Kt/V.
1.13
1.13. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 13 Urea reduction ratio (URR).
1.14
1.14. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 14 Pre‐dialysis beta 2 microglobulin (mg/L).
1.15
1.15. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 15 Patients with amyloid.
1.16
1.16. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 16 Total cholesterol (mmol/L).
1.17
1.17. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 17 HDL cholesterol (mmol/L).
1.18
1.18. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 18 LDL cholesterol (mmol/L).
1.19
1.19. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 19 Triglycerides (mmol/L).
1.20
1.20. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 20 Serum albumin (g/dL).
1.21
1.21. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 21 Protein catabolic rate (PCR).
1.22
1.22. Analysis
Comparison 1 Synthetic versus cellulose/modified cellulose haemodialysis membranes, Outcome 22 Mortality.
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Update of

References

References to studies included in this review

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References to studies excluded from this review

Al‐Madani 2000 {published data only}
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Kobayashi 2003 {published data only}
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Kramer 1992 {published data only}
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Matos 2000 {published data only}
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Memoli 2000 {published data only}
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Memoli 2002 {published data only}
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Mudge 2005 {published data only}
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Munger 2000 {published data only}
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Navarro 1992 {published data only}
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Ohi 2001 {published data only}
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Opatrny 1993 {published data only}
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Pertosa 2002a {published data only}
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Schaefer 1994 {published data only}
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References to ongoing studies

Ornt 2002 {published data only}
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Additional references

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References to other published versions of this review

MacLeod 1998
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