Background Recently, several pharmaceutical companies have developed new medium cut-off (MCO) dialyzers for expanded hemodialysis (HDx). This study aimed to compare the safety and efficacy of four MCO dialyzers between them and with high-flux hemodialysis (HD) and post-dilution hemodiafiltration (HDF). Methods A prospective study was carried out on 23 patients who underwent six dialysis sessions: two sessions with the FX80 Cordiax in HD and HDF, and four HDx sessions with the Phylther 17-SD, Vie-18X, Elisio HX19, and Theranova 400 dialyzers. The reduction ratios (RR) of urea, creatinine, ß2-microglobulin, myoglobin, kappa FLC, prolactin, α1-microglobulin, α1-acid glycoprotein, lambda FLC, and albumin were compared. Dialysate albumin loss was also measured. Results The differences in efficacy between the evaluated dialyzers were minimal in small molecules and even up to the β2-microglobulin's size. The main differences were found between myoglobin, ķFLC, prolactin, α1-microglobulin, and λFLC RRs, in which all four MCO dialyzers, with similar efficacy, were clearly superior to HD and slightly inferior to HDF treatment. Albumin losses in the dialysate with HD dialyzers were less than 1 gram and between 1.5 to 2.5 grams in HDx and HDF. The global removal score values were similar in all four HDx treatments, and again significantly higher than those with HD. Conclusions The results of the four MCO dialyzers evaluated in this study showed good efficiency with no significant performance differences between them while being completely safe in terms of albumin loss. Likewise, the study confirms the superiority of HDx over high-flux HD with an efficacy close to that of post-dilution HDF.

Background and Aims a growing number of octogenarians or older patients are being admitted to the intensive care unit (ICU). The aim of this study was to assess factors associated with acute renal replacement therapy (ARRT) requirement in these patients and the impact of ARRT on the 90-day ICU mortality. Also we aimed to identify prognostic factors associated with mortality risk in the group of patients that required ARRT. Method retrospective study of octogenarian or older patients admitted to the ICUs of Hospital Clínic de Barcelona from June 2007 to April 2019. Patients on chronic dialysis treatment or kidney transplant, and patients with limitation of therapeutic support or admitted for less than 48 hours were excluded. Results 217 patients were included in the study, of which 36.4% required ARRT. Use of vasoactive drugs and Sequential Organ Failure Assessment (SOFA) score on admission were higher in ARRT patients (p=0.009 and <0.001). Basal estimated glomerular filtration rate (eGFR) was lower in the ARRT cohort (p<0.001). Hospital and ICU length of stay were longer in the ARRT cohort (p<0.001). Ninety-day mortality was 58.2% in the ARRT cohort and 55.8% in the control cohort, without statistical differences. In the survival analysis, only female sex and non-renal SOFA ≥6.5 were significantly associated with mortality (p= 0.005 and 0.002 respectively) in the ARRT cohort. Conclusion mortality was not significatively increased in the octogenarian population that required and got ARRT respect to those who did not require it. Scores like SOFA can help in the process of decision making about initiation of ARRT.

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