Nephrol Dial Transplant (2003) 18: 1059-1060
© 2003 European Renal Association-European Dialysis and Transplant Association
Personal Opinion
Reflections on the HEMO study: the American viewpoint
1 Renal Research Institute, New York, USA and 2 Lister Renal Unit, East and North Hertforshire NHS Trust, Stevenage, UK
Keywords: dialysis dose; haemodialysis; HEMO study; membrane flux; randomized controlled trials
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When such a large study as the NIH sponsored HEMO trial reports, it is sobering to first ask if it was all worth it. After all, we know that randomized controlled trials (RCTs) tend to be hugely expensive, be lengthy in their execution and that they can explore causality for only a few parameters. Recognizing that at the outset the planners had a long list of issues which they had to prioritize (for example, they chose not to study membrane biocompatibility) most would probably agree that the final short list (dialysis dose and membrane flux) was wisely chosen as these issues remain central concerns for those engaged in day-to-day haemodialysis therapy. In particular, there is continuing worry that the convergence of practice worldwide—to much shorter, more aggressive schedules which has been brought about by economic pressures, improved patient tolerance and preference—is resulting in systematic under-dialysis. While many would probably have
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