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See 1 citation in Nephrol Dial Transplant 2017:

Nephrol Dial Transplant. 2017 Jan 1;32(1):165-172. doi: 10.1093/ndt/gfw310.

Performance of hemodialysis with novel medium cut-off dialyzers.

Author information

1
Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
2
Division of Nephrology, Department of Medicine, University Hospital, Würzburg, Germany.
3
Gambro Lundia AB, Baxter Renal Therapeutic Area, Lund, Sweden.
4
Gambro Dialysatoren GmbH, Baxter Renal Therapeutic Area, Hechingen, Germany.
5
Baxter Healthcare Corporation, Life Science & Operations, Round Lake, IL, USA.
6
Department of Internal Medicine, LKH Hochsteiermark, Bruck, Austria.

Abstract

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.

KEYWORDS:

beta2-microglobulin; dialysis; hemodiafiltration; hemodialysis; uremic toxins

PMID:
27587605
PMCID:
PMC5837492
DOI:
10.1093/ndt/gfw310
[Indexed for MEDLINE]
Free PMC Article

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