scholarly journals P1102EVALUATION THE EFFICACY OF MEDIUM CUT- OFF MEMBRANE DIALYZERS AND COMPARISON WITH HIGH FLUX DIALYZERS IN CONVENTIONAL HEMODIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Irena Rambabova Bushljetikj ◽  
Lada Trajcheska ◽  
Vladimir Pushevski ◽  
Sefedin Biljali ◽  
Trajan Balkanov
Keyword(s):  
Removal Rate ◽  
Uremic Toxins ◽  
High Flux ◽  
Removal Rates ◽  
Innovative Therapy ◽  
New Class ◽  
Number Of Patients ◽  
Middle Molecules ◽  
Dialysis Membranes

Abstract Background and Aims Hemodialysis (HD) is the most widely used modality of renal replacement therapy. The high-flux dialyzers in standard hemodialysis offer numerous benefits for ESRD patients, such as, increasing the uremic toxins removal and improving patients survival, reduced patients admission and morbidity. A new class of membranes, medium cut-off (MCO) membranes, has been designed to achieve better removal capacities for middle and large middle molecules, as well as to ensure the retention of albumin in hemodialysis (HD) treatments. We evaluated the removal efficacy of Theranova® in standard HD in comparison with standard high- flux HD. Method Four stable HD patients (M/F 1/4) were included in 12-weeks small observational pilot study in HD with Theranova® 400 (sup. 1.7 m2) and Theranova® 500 (sup. 2.0 m2) dialyzers. Each patient was assessed four times, T0 with standard high flux dialyzers, T1 at 1 month, T2 at second month and T3 at third month, by measuring pre and post-HD samples of: urea, creatinine, beta2-microglobilin (B2M), myoglobin, albumin and FLC-k, FLC-λ . Data are reported as mean ± standard deviation (SD). The removal rates of uremic toxins are expressed as percentages. Results The average removal rates for the uremic toxins with standard high-flux membranes were 18.4% for B2M, 14.3% for Myoglobin, 19.8 % for FLC-k and 17.4 % for FLC-λ. The data showed a higher average removal rate for all the uremic toxins with Theranova® dialyzers for B2M, Myoglobin, FLC-k and FLC-λ (62.7%, 56.9%, 63.5%, 54.6%, respectively) during the 3 months of follow up. The using of Theranova® dialyzers in standard HD was enough to significantly decrease the pre-dialysis value of Urea (17.72 ± 2.26 vs 13.75 ± 3.75, p=0.001), Creatinine (700.50 ± 315.07 vs 570.00 ± 206.64, p=0.021), B2M (40.90 ± 11.00 vs 29.00 ± 4.64, p=0.005), FLC-k (267.25 ± 113.28 vs 225.25 ± 100.62, p=0.018), FLC-λ (324.25 ± 116.12 vs 215.23 ± 64.44, p=0.011), Myoglobin ( 199.96 ± 124.41 vs 137.00 ± 83.14, p= 0.049). Finally, albumin retention was observed with Theranova® dialyzers, between T0 and T3 it increased significantly (40.50 ± 4.79 vs 42.25 ± 4.50, p=0.0001). Conclusion Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules in mid -term report. But the long term analysis and larger number of patients is necessary to evaluate a clinical significance of this innovative therapy.

Efficacy of Medium Cut-Off Dialyzer and Comparison with Standard High-Flux Hemodialysis

2020 ◽  
pp. 1-7
Author(s):  
Irena Rambabova Bushljetik ◽  
Lada Trajceska ◽  
Sefedin Biljali ◽  
Trajan Balkanov ◽  
Petar Dejanov ◽  
...  
Keyword(s):  
Pilot Study ◽  
Removal Rate ◽  
Uremic Toxins ◽  
Light Chains ◽  
High Flux ◽  
Free Light Chains ◽  
Middle Molecules

<b><i>Background:</i></b> A new medium cut-off (MCO) membranes has been designed to achieve better removal capacities for middle and large middle molecules in hemodialysis (HD) treatment. <b><i>Aim:</i></b> The aim of this study was to evaluate the removal efficacy of Theranova® in standard HD in comparison with standard high-flux HD. <b><i>Methods:</i></b> Four HD patients (M/F 1/4) were included in 12-week observational pilot study in HD with Theranova® 400 and Theranova® 500 dialyzers. Each patient was assessed 4 times, <i>T</i><sub>0</sub> with high-flux dialyzers, <i>T</i><sub>1</sub> at 1 month, <i>T</i><sub>2</sub> at second month, and <i>T</i><sub>3</sub> at third month, by measuring pre- and post-HD samples of urea, Cr, β2-microglobilin (β2M), myoglobin, albumin, free light chains kappa (FLC-k), and free light chains lambda (FLC-λ). <b><i>Results:</i></b> The data showed a higher average removal rate for all the uremic toxins with Theranova® dialyzers for β2M, myoglobin, FLC-k, and FLC-λ (62.7, 56.9, 63.5, and 54.6%, respectively) during the 3 months. Albumin retention was observed and did not change between <i>T</i><sub>0</sub> and <i>T</i><sub>3</sub> (<i>p</i> = 0.379). <b><i>Conclusion:</i></b> Compared to high-flux membranes, MCO membranes show greater permeability for middle molecules in midterm report.

scholarly journals Comparison of the removal of uraemic toxins with medium cut-off and high-flux dialysers: a randomized clinical trial

2019 ◽  
Author(s):  
Mohamed Belmouaz ◽  
Marc Bauwens ◽  
Thierry Hauet ◽  
Valentin Bossard ◽  
Pierre Jamet ◽  
...  
Keyword(s):  
Fibroblast Growth Factor 23 ◽  
High Flux ◽  
Catabolic Rate ◽  
Middle Molecules ◽  
Secondary Endpoints ◽  
Potential Benefits ◽  
To Receive ◽  
And Oxidative Stress ◽  
Protein Catabolic Rate

Abstract Background Accumulation of middle-weight uraemic toxins in haemodialysis (HD) patients results in increased morbidity and mortality. Whether medium cut-off HD (MCO-HD) improves removal of middle-weight uraemic toxins remains to be demonstrated. Methods This cross-over prospective study included 40 patients randomly assigned to receive either 3 months of MCO-HD followed by 3 months of high-flux HD (HF-HD), or vice versa. The primary endpoint was myoglobin reduction ratio (RR) after 3 months of MCO-HD. Secondary endpoints were the effect of MCO-HD on other middle-weight toxins and protein-bound toxins, and on parameters of nutrition, inflammation, anaemia and oxidative stress. Results Compared with HF-HD, MCO-HD provided higher mean RR of myoglobin (36 ± 8 versus 57 ± 13%, P < 0.0001), beta2-microglobulin (68 ± 6 versus 73 ± 15%, P = 0.04), prolactin (32 ± 13 versus 59 ± 11%, P < 0.0001), fibroblast growth factor 23 (20 ± 21 versus 41 ± 22%, P = 0.0002), homocysteine (43 ± 7 versus 46 ± 9%, P = 0.03) and higher median RR of kappa [54 (48–58) versus 70 (63–74)%, P < 0.0001] and lambda free light chain (FLC) [15 (9–22) versus 44 (38–49)%, P < 0.0001]. Mean ± SD pre-dialysis levels of beta2-microglobulin (28.4 ± 5.6 versus 26.9 ± 5.1 mg/L, P = 0.01) and oxidized low-density lipoprote (6.9 ± 4.4 versus 5.5 ± 2.5 pg/mL, P = 0.04), and median (interquartile range) kappa FLC [145 (104–203) versus 129 (109–190) mg/L, P < 0.03] and lambda FLC [106 (77–132) versus 89 (62–125) mg/L, P = 0.002] were significantly lower. Mean albumin levels decreased significantly (38.2 ± 4.1 versus 36.9 ± 4.3 g/L, P = 0.004), without an effect on nutritional status as suggested by unchanged normalized protein catabolic rate and transthyretin level. Conclusions Compared with HF-HD, MCO-HD provides higher myoglobin and other middle molecules RR and is associated with moderate hypoalbuminemia. The potential benefits of this strategy on long-term clinical outcomes deserve further evaluation.

Influence of Dialysis Membranes on the Convective Transport of Middle Molecules

1986 ◽  
Vol 9 (6) ◽  
pp. 421-426 ◽  
Author(s):  
A.L. M. de Francisco ◽  
J. Gordillo ◽  
J.G. Cotorruelo ◽  
L. Ruiz ◽  
M. Gonzalez ◽  
...  
Keyword(s):  
High Performance ◽  
Convective Transport ◽  
Maintenance Hemodialysis ◽  
Gel Chromatography ◽  
High Flux ◽  
Solute Transfer ◽  
Effective Form ◽  
Middle Molecules ◽  
Dialysis Membranes ◽  
Chromatographic Profiles

Ultrafiltrates from 10 patients in chronic maintenance hemodialysis (7 males and 3 females) were obtained simultaneously using three different membranes: cuprophan, polyacrilonitrile and polysulfone. Middle molecules (MM) chromatographic profiles and total MM amount were determined by gel chromatography and high performance liquid chromatography. The convective transport of MM was similar and not membrane related. Hemofiltration, a predominantly convective solute transfer procedure using high flux membranes such as polyacrilonitrile and polysulfone, in which large amounts of fluids have to be ultrafiltered, is an effective form of MM removal.

scholarly journals A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear)

Toxins ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 317
Author(s):  
Hussain Allawati ◽  
Linda Dallas ◽  
Sreejith Nair ◽  
Janine Palmer ◽  
Shaiju Thaikandy ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
High Flux ◽  
Serum Concentrations ◽  
Single Centre ◽  
Open Label ◽  
Median Percentage ◽  
Middle Molecules ◽  
Dialysis Membranes ◽  
Trough Concentrations ◽  
To Receive

Medium cut-off membrane (MCO) dialysers have been shown to remove a range of middle molecules, which are associated with adverse outcomes in haemodialysis (HD) patients, more effectively than high-flux HD. Vancomycin is widely used in HD patients for treating a variety of infections. To avoid subtherapeutic trough concentrations, it is important to understand vancomycin clearance in patients undergoing HD with the MCO membrane. This open label single centre, cross-over clinical study compared the vancomycin pharmacokinetics in chronic HD patients using MCO membrane (Theranova) and high-flux membrane (Revaclear). Five patients established on chronic HD who were due to receive vancomycin were enrolled. The study used alternating Theranova and Revaclear dialysis membranes over six consecutive sessions. Vancomycin was administered over the last one to two hours of each HD session. The maintenance dose was adjusted based on pre-HD serum concentrations. Over the 210 study samples, vancomycin clearance was higher with MCO-HD compared to high-flux HD but not statistically significant. Median percentage of vancomycin removal at 120 min by MCO membrane was 39% (20.6–51.5%) compared with 34.1% (21.3–48.4%) with high-flux HD. MCO-HD removes a slightly higher percentage of vancomycin at 120 min into dialysis compared to high-flux membrane dialysis in HD patients with infections. Application of vancomycin during the last one to two hours of each dialysis is required to maintain therapeutic concentrations to minimise loss through the dialyser and maintain therapeutic levels.

scholarly journals Expanded hemodialysis: new opportunities and hopes

2020 ◽  
pp. 47-51
Author(s):  
L. Surzhko
Keyword(s):  
Quality Of Life ◽  
Uremic Toxins ◽  
Dialysis Patients ◽  
Gradual Improvement ◽  
Large Molecules ◽  
Evolutionary Changes ◽  
Potential Benefits ◽  
Dialysis Membranes

In the field of hemodialysis technologies, as in other fields of medicine, evolutionary changes are constantly taking place. The innovations are driven by unachieved clinical outcomes and desire to improve the quality of care of patients with CKD 5D. Recent advances in dialysis techniques resulted in the possibility to expand the permeability of dialysis membranes for a wider spectrum of uremic toxins that lead to the enhancement of long-term outcomes improving quality of life and reducing the mortality rate of dialysis patients. The inadequacy of existent dialysis techniques, at least in part, is due to the chronic accumulation of organic retention solutes of middle and large molecules, which are poorly or even not removed during dialysis. A gradual improvement in the elimination of uremic toxins is observed as a result of the development of new alternative approaches of hemodialysis therapy, such as high-flux hemodialysis, hemodiafiltration, expanded hemodialysis (HDx). However, some techniques have had limited success due to a host number of organizational, technological, financial and human factors. Expanded hemodialysis offers a novel blood purification technology in removal of the large spectrum of uremic toxins, in particular large medium molecules, due to the new structure of the dialysis membrane. There are a number of studies that prove the potential benefits of a new method of dialysis therapy over the previous ones, suggesting a reduction in cardiovascular mortality, vascular calcification and inflammation. In addition, there is evidence of a positive effect of HDx on the quality of life in dialysis patients. In particular, to minimize the manifestations of skin itching, restless legs syndrome, asthenic syndrome.

scholarly journals P1098THE CHANGE OF PLASMA SCLEROSTIN AND OTHER BIOMARKERS IN HEMODIALYTIC PATIENTS USING DIALYZER WITH MEDIUM CUT-OFF MEMBRANE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jong Hwan Jung ◽  
Seon-Ho Ahn ◽  
Ju Hung Song
Keyword(s):  
Molecular Weight ◽  
Vascular Calcification ◽  
Plasma Levels ◽  
Cardiovascular Complications ◽  
Uremic Toxins ◽  
Control Group ◽  
High Flux ◽  
Middle Molecules ◽  
Significant Difference ◽  
Fgf 23

Abstract Background and Aims Protein-bound toxins and uremic toxins with middle molecular weight usually develop uremic symptoms in patients with advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD). Although the effect on uremic toxicity of the molecules is not proven yet, middle molecules or larger middle molecules is regarded with important substance concerning of development of uremic symptoms and cardiovascular complication, particularly in CKD patients. Hemodialysis (HD) or hemodiafiltration (HDF) using dialyzer with high flux membrane provided improved clearance for uremic toxins with middle molecular weights. However, uremic toxins with larger middle molecular weight could not be easily removed through above methods. Medium cut-off (MCO) membrane can remove larger middle molecules which can be not removed through high flux membrane and HDF. From this perspective, chronic use of MCO membrane lowering the plasma concentration of larger middle molecules associated with cardiovascular complications including vascular calcification may give beneficial effect, particularly in patients with ESRD. Method Twenty-five patients undergoing chronic hemodialysis were prospectively analyzed for 6 months. We randomly divided enrolled patients into two groups: control group and MCO group. Patients in the control group used dialyzer with high flux membrane and patients in MCO group used dialyzer with MCO membrane. The enrolled patients performed hemodialysis thrice a week during 6 months. We measured plasma levels of several biomarkers at baseline and 3-month and 6-month through the multiplexing using Luminex® technology. In this prospective study, we performed comparative analysis with larger middle molecules, such as CXCL16, sclerostin, and FGF-23, in both groups. Results The plasma levels of all biomarkers at baseline did not show significant difference between two groups (CXCL16: p =0.904, Sclerostin: p =0.322, FGF-23: p =0.065, respectively). However, plasma sclerostin levels at 3-month and 6-month were significantly lower in MCO group (p = 0.060, p &lt;0.005, respectively). In addition, even after analysis of covariance through ANCOVA analysis, plasma sclerostin levels at 3-month and 6-month were significantly lower in MCO group compared with the control group (p = 0.042, p =0.001, respectively). But, there was no a significant decrease of plasma sclerostin levels according to time, particularly in MCO group (p = 0.157, p =0.412, respectively) (Figure 1). Conclusion This study showed the 6-month outcome for changes of the plasma levels of larger middle molecules, including CXCL16, sclerostin, and FGF-23, particularly in dialytic patients using dialyzer with MCO membrane. Plasma sclerostin associated with vascular calcification showed decreasing tendency during 6 months after application of MCO membrane, but, there was no statistical significance. However, plasma levels of sclerostin were significantly lower in dialytic patients using MCO membrane than those using high flux membrane at 3 and 6 months, respectively. Therefore, hemodialysis using dialyzer with MCO membrane may be an option to attenuate cardiovascular complications in ESRD patients.

scholarly journals Rationale for Medium Cutoff Membranes in COVID-19 Patients Requiring Renal Replacement Therapy

Nephron ◽  
2020 ◽  
Vol 144 (11) ◽  
pp. 550-554
Author(s):  
Claudio Ronco ◽  
Thiago Reis ◽  
Mario Cozzolino
Keyword(s):  
Chronic Kidney Disease Stage ◽  
Kidney Injury ◽  
Preventive Measure ◽  
Uremic Toxins ◽  
Disease Stage ◽  
Maintenance Hemodialysis ◽  
Social Distancing ◽  
Extracorporeal Blood Purification ◽  
Middle Molecules

The current pandemic of coronavirus disease 2019 (COVID-19) spotlighted the vulnerability of patients with chronic kidney disease stage 5 on maintenance hemodialysis (HD) to the viral infection. Social distancing is the most effective preventive measure to reduce the risk of infection. Nonetheless, the necessity to frequently reach the dialysis center and the inherent social gathering both impede social distancing and also self-quarantine for infected individuals. A baseline hyperinflammatory state driven by factors such as the retention of uremic toxins afflicts these patients. Concomitantly, a condition of relative immunosuppression is also attributed to similar factors. The use of high-flux (HF) dialyzers for HD is the standard of care. However, with HF membranes, the removal of large middle molecules is scant. Medium cutoff (MCO) dialyzers are a new class of membranes that allow substantial removal of large middle molecules with negligible albumin losses. Recent trials confirmed long-term safety and long-term sustained reduction in the concentration of large uremic toxins with MCO dialyzers. Herein, we discuss the rationale for applying MCO membranes in COVID-19 patients and its possible immunoadjuvant effects that could mitigate the burden of COVID-19 infection in dialysis patients. We also discuss the direct cytopathic effect of the virus on renal tissue and extracorporeal blood purification techniques that can prevent kidney damage or reduce acute kidney injury progression.

High-Flux versus High-Retention-Onset Membranes: In vivo Small and Middle Molecules Kinetics in Convective Dialysis Modalities

2019 ◽  
Vol 49 (1-2) ◽  
pp. 8-15 ◽  
Author(s):  
Isis S.F. Cordeiro ◽  
Lilian Cordeiro ◽  
Carolina S. Wagner ◽  
Luiza Karla R.P. Araújo ◽  
Benedito J. Pereira ◽  
...  
Keyword(s):  
Total Mass ◽  
Crossover Trial ◽  
Maintenance Hemodialysis ◽  
High Flux ◽  
Serum Concentrations ◽  
Middle Molecules ◽  
Dialysis Membranes ◽  
Poor Outcomes ◽  
Beta 2 Microglobulin

Background: Patients undergoing maintenance hemodialysis (HD) exhibit increased levels of uremic toxins, which are associated with poor outcomes. Recently, new dialysis membranes have allowed clearance of solutes with higher molecular weight, without significant albumin losses high-retention-onset-HD (HRO-HD). Methods: Prospective crossover trial, in which 16 prevalent patients switched from high-flux HD (HF-HD) to online hemodiafiltration (olHDF) and HRO-HD for 4 weeks. The following variables were evaluated: pre- and post-dialysis serum concentrations of albumin, urea, phosphate (P), beta-2 microglobulin (β2M), and total mass (TM) extraction and dialyzer clearance of urea, P, and β2M. Results: Comparing HF-HD, olHDF, and HRO-HD, respectively, there were no differences regarding pre-dialysis serum concentrations of albumin (3.94 ± 0.36, 4.06 ± 0.22, and 3.93 ± 0.41 g/dL, p = 0.495), urea (166 ± 29, 167 ± 30, and 164 ± 27 mg/dL, p = 0.971), P (4.9 ± 2.1, 5.2 ± 1.6, and 4.9 ± 2.1 mg/dL, p = 0.879), and β2M (31.3 ± 7.1, 32.6 ± 8.6, and 33.7 ± 5.9 µg/mL, p = 0.646). β2M clearance was significantly lower in HF-HD in comparison to both olHDF and HRO-HD: 43 (37–53) versus 64 (48–85) mL/min, p = 0.013, and 69 (58–86) mL/min, p = 0.015, respectively. Post-dialysis β2M serum concentration was higher in HF-HD in comparison to olHDF and HRO-HD: 11.6 (9.6–12.4) vs. 5.7 (4.5–7.0) µg/mL, p = 0.001, and 5.6 (5.3–7.6) µg/mL, p = 0.001, respectively. TM extraction of urea, P, and β2M were similar across the 3 dialysis modalities. Conclusions: olHDF and HRO-HD were superior to HF-HD regarding β2M clearance, leading to lower post-dialysis β2M levels.

scholarly journals P1105CAN BETTER EFFICACY OF MIDDLE WEIGHT MOLECULES REMOVAL IN DIALYSIS PATIENTS TREATED WITH MEDIUM CUT-OFF MEMBRANES PREDICT SUPERIORITY OVER CONVENTIONAL HIGH FLUX DIALYSERS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Ostojic ◽  
Rodoljub Markovic
Keyword(s):  
Uremic Toxins ◽  
High Flux ◽  
Polysulfone Membrane ◽  
Laboratory Parameters ◽  
Middle Molecules ◽  
Group 2 ◽  
One Year ◽  
Dialysis Time ◽  
Group 1

Abstract Background and Aims During last two decades there was a significant improvement in dialysis field, especially with introducement of high flux haemodialysis and on-line haemodiafiltration. In recent years, expanded haemodialysis has emerged as a new attempt to imrove effectiveness of dialysis. These so called medium cut-off membranes (MCO), allow removal of wider range of uremic toxins, especially middle weight molecules, most of which have important role in chronic inflammation and mortality. The aim of this prospective pilot study was to evaluate the effectiveness of middle molecules and other uremic toxins removal in patients treated with medium cut-off membrane (Theranova 500tm, Baxter), compared with patients on conventional high flux dialysis programme. Method We examined 10 patients on chronic haemodialysis programme, five of them dialyzed with Theranova 500tm dialyser for one year, and other five patients dialyzed with high flux membranes (polysulfone membrane, 1.8m2) during the same period. Patients were matched according to their age, sex, main disease, and the beginning of dialysis. Analyzed laboratory parameters were urea, creatinine, calcium, phosphorus, PTH, and hemoglobin, on the beginning of the study and after one year follow up, while hepcidin and β2 microglobulin levels were measured only in the end of follow up period. We used descriptive and analytic statistical methods (T test for independent and dependent means). Results Patients were divided in two groups, Group 1 - dialyzed with Theranova, and Group 2- patients on high flux haemodialysis, both followed during one year period (Group 1: 63.2±7.01 years, 3 males and 2 women, one of them with polycystic kidney disease (PCKD), the other four with hypertension as main disease, median dialysis time 54.6±8.32 months, Group 2: 63±6 years, 3 males, 2 women, main disease in one was PCKD, in other four hypertension, median dialysis time 53.6±17.98months). Our patients didn’t differ statistically in basic examined laboratory parameters on the beginning of examination (mean urea 21.38±2.15 vs. 27.44±3.93 mmol/ (p&gt;0.05), mean creatinine 936±88.5 vs. 927.6±98.8µmol/L, mean albumin 40±2.54 vs 39.8±2.77g/L (p&gt;0.05), mean calcium 2,24±0.16 vs 2.21±0.17mmol/L (p&gt;0.05), mean phosphorus level 1,84±0.39 vs 1.67±0.56mmol/L (p&gt;0.05), mean parathyroid hormone level 266.16±279.64 vs 236.14±43.99pg/mL (p&gt;0.05), and mean hemoglobin 122.2±5.72 vs 106.4±8.62g/L (p&gt;0.05). In patients on high flux haemodialysis programme there was no significant change in examined parameters during one year follow-up (for all examined parameters p value was &gt;0.05). After switching the first group on Theranova dialysers for one year there was small but statistically significant rise in urea (23.26±2.02mmol/L, p&lt;0.05), and also statistically significant decrease in serum creatinine level (840.2±75.34µmol/L, p&lt;0.05) in this group, while other parameters were not statistically significant. Comparing two groups after one year follow up, there was statistically significant higher level of hemoglobin in the first group (112.2±7.46 vs. 102g/L ±4.47, p&lt;0.05), and statistically significant decrease of beta-2 microglobuline (27.41±2.58 vs. 33.82± 2.47ng/mL, p&lt;0.05) and hepcidin (75.64±32.2 vs 100.26±10.58ng/mL, p&lt;0.05), while other parameters didn’t show statistical significance. Conclusion Our results implicate better clearance of middle weight molecules (B2M, hepcidin) in patients treated with Theranova 500 tm membrane, which could suggest anti-inflammatory effect of medium cut-off membranes, additionaly with the higher hemoglobin level after one year treatment, comparing to conventional high flux dialysis. Our results are promising, but need to be confirmed in larger randomized trials.

scholarly journals P1078IMPACT OF A MEDIUM CUT-OFF DIALYZER ON SKIN AUTOFLUORESCENCE IN HAEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Daniela Viramontes Horner ◽  
Nitin Kolhe ◽  
Janson Leung ◽  
Richard Fluck ◽  
Nicholas Selby ◽  
...  
Keyword(s):  
Observational Study ◽  
High Flux ◽  
Skin Autofluorescence ◽  
Long Term Outcomes ◽  
Published Evidence ◽  
Middle Molecules ◽  
Glycation End Products ◽  
The Impact

Abstract Background and Aims Advanced glycation end-products (AGEs) are middle-sized uraemic toxins that accumulate in haemodialysis (HD) patients due to increased production, impaired excretion and insufficient removal. Previous studies have reported that the use of a medium cut-off (MCO) dialyzer promotes a greater removal of larger middle molecules (such as AGEs) than conventional high-flux HD and haemodiafiltration. However, to our knowledge, there is no published evidence regarding the effect of an MCO dialyzer on skin autofluorescence (SAF), a measure of long-term tissue AGE accumulation and independent risk factor for mortality in the HD population. We aimed to investigate the impact of using an MCO dialyzer on change in SAF over time in HD patients. Method HD patients were enrolled in a prospective observational study. SAF was measured using a validated Autofluorescence Reader at baseline, 12 and 24 months. During the initial 12 months patients dialysed using high-flux polysulphone, polyarylethersulfone or polyvinylpyrrolidone dialyzers. At a variable time after 12 months patients were switched to an MCO dialyzer (Theranova; Baxter®). Forty patients who had been using the MCO dialyzer for at least 3 months were included in this analysis. Results Mean age, baseline SAF levels and time on MCO dialyzer were 63±13 years, 3.5±0.9 arbitrary units (AU) and 124±49 days, respectively. SAF increased significantly from baseline to 12 months (3.5±0.9 vs. 3.9±1.1 AU; p&lt;0.0001) but tended to decrease between 12 and 24 months, after conversion to an MCO dialyzer (3.9±1.1 vs. 3.7±0.7 AU; p=0.06). Additionally, mean ΔSAF from baseline to 12 months was positive (0.41±0.68 AU) whereas ΔSAF from 12 to 24 months was negative (-0.18±0.76 AU; p=0.002 for comparison). Furthermore, SAF at 24 months correlated negatively and significantly with time on MCO dialyzer (r= -0.384; p=0.01) though second year ΔSAF (delta from 12 to 24 months) did not (r= 0.061; p=0.7). Conclusion We found in this observational study that SAF levels decreased/stabilised in HD patients after switching to an MCO dialyzer compared to the time when patients were using conventional high-flux HD and haemodiafiltration, during which SAF levels increased. Future prospective and interventional studies with larger sample sizes and longer follow-up are needed to confirm these findings and to evaluate the impact of using an MCO dialyzer on long-term outcomes, including survival.

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