Removal of Middle Molecules and Dialytic Albumin Loss: A Cross-over Study of Medium Cutoff and High-Flux Membranes with Hemodialysis and Hemodiafiltration

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Key Points

HDF and MCO have shown greater clearance of middle-size uremic solutes in comparison with HF dialyzers; MCO has never been studied in HDF.
MCO in HDF does not increase the clearance of B2M and results in a higher loss of albumin.

Background

Middle molecule removal and albumin loss have been studied in medium cutoff (MCO) membranes on hemodialysis (HD). It is unknown whether hemodiafiltration (HDF) with MCO membranes provides additional benefit. We aimed to compare the removal of small solutes and β2-microglobulin (B2M), albumin, and total proteins between MCO and high-flux (HFX) membranes with both HD and HDF, respectively.

Methods

The cross-over study comprised 4 weeks, one each with postdilutional HDF using HFX (HFX-HDF), MCO (MCO-HDF), HD with HFX (HFX-HD), and MCO (MCO-HD). MCO and HFX differ with respect to several characteristics, including membrane composition, pore size distribution, and surface area (HFX, 2.5 m ²; MCO, 1.7 m ²). There were two study treatments per week, one after the long interdialytic interval and another midweek. Reduction ratios of vitamin B12, B2M, phosphate, uric acid, and urea corrected for hemoconcentration were computed. Dialysis albumin and total protein loss during the treatment were quantified from dialysate samples.

Results

Twelve anuric patients were studied (six female patients; 44±19 years; dialysis vintage 35.2±28 months). The blood flow was 369±23 ml/min, dialysate flow was 495±61 ml/min, and ultrafiltration volume was 2.8±0.74 L. No significant differences were found regarding the removal of B2M, vitamin B12, and water-soluble solutes between dialytic modalities and dialyzers. Albumin and total protein loss were significantly higher in MCO groups than HFX groups when compared with the same modality. HDF groups had significantly higher albumin and total protein loss than HD groups when compared with the same dialyzer. MCO-HDF showed the highest protein loss among all groups.

Conclusions

MCO-HD is not superior to HFX-HD and HFX-HDF for both middle molecule and water-soluble solute removal. Protein loss was more pronounced with MCO when compared with HFX on both HD and HDF modalities. MCO-HDF has no additional benefits regarding better removal of B2M but resulted in greater protein loss than MCO-HD.

Related collections

Most cited references 36

Record: found
Abstract: found
Article: not found

High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.

Francisco Maduell, Francesc Moreso, Mercedes Pons … (2013)

Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.

0 comments Cited 99 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Medium Cut-Off (MCO) Membranes Reduce Inflammation in Chronic Dialysis Patients—A Randomized Controlled Clinical Trial

Daniel Zickler, Ralf Schindler, Kevin Willy … (2017)

Background To increase the removal of middle-sized uremic toxins a new membrane with enhanced permeability and selectivity, called Medium Cut-Off membrane (MCO-Ci) has been developed that at the same time ensures the retention of albumin. Because many middle-sized substances may contribute to micro-inflammation we hypothesized that the use of MCO-Ci influences the inflammatory state in hemodialysis patients. Methods The randomized crossover trial in 48 patients compared MCO-Ci dialysis to High-flux dialysis of 4 weeks duration each plus 8 weeks extension phase. Primary endpoint was the gene expression of TNF-α and IL-6 in peripheral blood mononuclear cells (PBMCs), secondary endpoints were plasma levels of specified inflammatory mediators and cytokines. Results After four weeks of MCO-Ci the expression of TNF-α mRNA (Relative quantification (RQ) from 0.92 ± 0.34 to 0.75 ± 0.31, -18.5%, p<0.001)-α and IL-6 mRNA (RQ from 0.78 ± 0.80 to 0.60 ± 0.43, -23.1%, p<0.01) was reduced to a significantly greater extent than with High-flux dialyzers (TNF mRNA-RQ: -14.3%; IL-6 mRNA-RQ: -3.5%). After retransformation of logarithmically transformed data, measurements after MCO were reduced to 82% of those after HF (95% CI 74%–91%). 4 weeks use of MCO-Ci resulted in long-lasting change in plasma levels of several cytokines and other substances with a significant decrease for sTNFR1, kappa and lambda free light chains, urea and an increase for Lp-PLA2 (PLA2G7) compared to High-flux. Albumin levels dropped significantly after 4 weeks of MCO dialysis but increased after additional 8 weeks of MCO dialysis. Twelve weeks treatment with MCO-Ci was well tolerated regarding the number of (S)AEs. In the extension period levels of CRP, TNF-α-mRNA and IL-6 mRNA remained stable in High-flux as well as in MCO-Ci. Conclusions MCO-Ci dialyzers modulate inflammation in chronic HD patients to a greater extent compared to High-flux dialyzers. Transcription of pro-inflammatory cytokines in peripheral leukocytes is markedly reduced and removal of soluble mediators is enhanced with MCO dialysis. Serum albumin concentrations stabilize after an initial drop. These results encourage further trials with longer treatment periods and clinical endpoints.

0 comments Cited 52 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Performance of hemodialysis with novel medium cut-off dialyzers

Alexander H. Kirsch, Raphael Lyko, Lars-Göran Nilsson … (2016)

Background. Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules. Methods. In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments. Results. MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF. Conclusions. MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC.

0 comments Cited 46 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Armando Armenta-Alvarez: Role: Role: Role: Role: Role: Role: Role: Role:

Salvador Lopez-Gil:

ORCID: https://orcid.org/0000-0001-6720-8146

Role: Role: Role: Role: Role: Role: Role:

Iván Osuna:

ORCID: https://orcid.org/0000-0002-3490-3414

Role: Role:

Nadja Grobe: Role: Role: Role: Role:

Xia Tao: Role:

Gabriela Ferreira Dias:

ORCID: https://orcid.org/0000-0003-4168-0375

Role:

Xiaoling Wang:

ORCID: https://orcid.org/0000-0002-4301-4133

Role:

Joshua Chao: Role: Role: Role: Role: Role:

Jochen G. Raimann:

ORCID: https://orcid.org/0000-0002-8954-2783

Role: Role:

Stephan Thijssen: Role:

Hector Perez-Grovas: Role: Role: Role:

Bernard Canaud:

ORCID: https://orcid.org/0000-0001-6854-2816

Role: Role: Role: Role: Role:

Peter Kotanko:

ORCID: https://orcid.org/0000-0003-4373-412X

Role: Role: Role: Role: Role: Role: Role:

Journal

Journal ID (nlm-ta): Kidney360

Journal ID (iso-abbrev): Kidney360

Journal ID (coden): KIDNEY

Journal ID (publisher-id): Kidney360

Title: Kidney360

Publisher: American Society of Nephrology

ISSN (Electronic): 2641-7650

Publication date Collection: August 2023

Publication date (Electronic): 12 June 2023

Volume: 4

Issue: 8

Pages: 1095-1102

Affiliations

[1 ]Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico

[2 ]Center for Research in Infectious Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico

[3 ]Research Division, Renal Research Institute, New York, New York

[4 ]Fresenius Medical Care, Fresnes, France

[5 ]Icahn School of Medicine at Mount Sinai, New York, New York

Author notes

Correspondence: Dr. Magdalena Madero, Department of Nephrology, INC Ignacio Chavez, Juan Badiano No. 1, Tlalpan, Mexico City 14080, Mexico. Email: madero.magdalena@ 123456gmail.com

Author information

Salvador Lopez-Gil https://orcid.org/0000-0001-6720-8146

Iván Osuna https://orcid.org/0000-0002-3490-3414

Gabriela Ferreira Dias https://orcid.org/0000-0003-4168-0375

Xiaoling Wang https://orcid.org/0000-0002-4301-4133

Jochen G. Raimann https://orcid.org/0000-0002-8954-2783

Bernard Canaud https://orcid.org/0000-0001-6854-2816

Peter Kotanko https://orcid.org/0000-0003-4373-412X

Magdalena Madero https://orcid.org/0000-0002-8154-8339

Article

Publisher ID: K360-2023-000466 Accession ID: 00014

DOI: 10.34067/KID.0000000000000185

PMC ID: 10476684

PubMed ID: 37651666

SO-VID: 4c5b1956-a7a2-4dfb-bb62-3461584e0abf

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

History

Date received : 1 June 2023

Date accepted : 1 June 2023

Page count

Figures: 2, Tables: 3, References: 36, Pages: 8

Custom metadata

Read-along YES

Keywords: hemodiafiltration,hemodialysis,medium cutoff membrane,expanded hemodialysis,uremic toxins

Data availability:

Keywords: hemodiafiltration, hemodialysis, medium cutoff membrane, expanded hemodialysis, uremic toxins

Removal of Middle Molecules and Dialytic Albumin Loss: A Cross-over Study of Medium Cutoff and High-Flux Membranes with Hemodialysis and Hemodiafiltration

Read this article at

Abstract

Abstract

Key Points

Background

Methods

Results

Conclusions

Related collections

Karger: Nephrology

Most cited references 36

High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.

Medium Cut-Off (MCO) Membranes Reduce Inflammation in Chronic Dialysis Patients—A Randomized Controlled Clinical Trial

Performance of hemodialysis with novel medium cut-off dialyzers

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Categories

Custom metadata

Comments

Comment on this article

Similar content 171

Most referenced authors 509