Comparison of cellulose diacetate and polysulfone membranes in the outcomeof acute renal failure. A prospective randomized study

Background. Whether the nature of haemodialysis (HD) membranes can influenc e the outcome of acute renal failure (ARF) remains debatable. Recent studie s have suggested that dialysis with bioincompatible unsubstituted cellulosi c membranes is associated with a less favourable patient outcome than dialy sis with biocompatible synthetic membranes. Since we generally use a modifi ed cellulosic membrane with substantially lower complement- and leukocyte-a ctivating potential than cuprophane, for dialysis of patients with ARF, and because there are no data in the literature regarding the influence of mod ified cellulosic membranes on the outcome of patients with ARF, we compared the outcome of ARF patients dialysed either with cellulose diacetate or wi th a synthetic polysulfone membrane. We also investigated the potential rol e of permeability by comparing membranes with high-flux versus low-flux cha racteristics. Methods. This prospective, randomized, single centre study included 159 pat ients with ARF requiring HD. Patients were stratified according to age, gen der, and APACHE II score and then randomized in chronological order to one of three dialysis membranes: low-flux polysulfone, high-flux polysulfone an d meltspun cellulose diacetate. Results. Aetiologies of ARF and the prevalence of oliguria were similarly d istributed among the three groups. There was no significant difference betw een the three groups for survival (multivariate Cox's proportional hazards model, P=0.57), time necessary to recover renal function (P=0.82), and numb er of dialysis sessions required before recovery (P=0.86). Multivariate ana lysis showed that survival was significantly influenced only by the severit y of the disease state (APACHE III score, P<0.0001), but not by the nature of the dialysis membrane (P=0.57) or the presence of oliguria (P=0.24). Conclusions. Among patients with ARF requiring HD survival and recovery tim e are aot significantly influenced by the use of either meltspun cellulose diacetate or the more biocompatible high-flux or low-flux polysulfone. Dial ysis using modified cellulose membranes is just as effective as dialysis us ing synthetic polysulfone membranes, but at a lower cost. In addition, the flux of the membrane did not influence patient outcome.