Biocompatibility and Performance of a Modified Cellulosic and a Synthetic High Flux Dialyzer

Grooteman, Muriël P.C.; Nubé, M. J.; Limbeek, J. van; Houte, A J van; Daha, Mohamed R.; Geelen, J. A. Van

doi:10.1097/00002480-199541020-00018

Cited by 24 publications

(3 citation statements)

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“…It has been observed that the transiently elevated plasma C3a and C5a levels shortly after treatment start are accompanied by a complementary reduction of peripheral blood leukocyte counts. The three dialyzers showed a similar overall pattern, but there was a significantly lower decrease with the FX CorAL 600 as compared with both other dialyzers, in line with previously published evidence (28). This observation supports an association of complement activation with pulmonary vascular leukocyte sequestration, and also suggests that leukocytes begin to reappear in the peripheral blood only when the complement activation diminishes (37).…”

Section: Discussionsupporting

confidence: 90%

“…All three dialyzers showed the typical pattern of a fast increase of the complement factors C3a and C5a, as measured 15 minutes after treatment start, which was significantly lower with both dialyzers with synthetic membranes compared with the dialyzer containing cellulose triacetate. These differences were more pronounced than previously published comparisons between polysulfone and cellulose triacetate dialyzers; however, the investigated membrane in the FX CorAL 600, and possibly also in the comparator membranes, differ from those studied earlier (28 –30). Our in vivo data are further supported by in vitro investigations confirming less activation of complement factors C3a, C5a, and sC5b-9 with the FX CorAL 600 than with the SureFlux 17UX (19).…”

Section: Discussioncontrasting

confidence: 70%

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Performance and Hemocompatibility of a Novel Polysulfone Dialyzer: A Randomized Controlled Trial

Ehlerding¹,

Erlenkötter

Gauly

et al. 2021

Kidney360

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Background: High-flux dialyzers shall effectively remove uremic toxins and be hemocompatible to minimize intradialytic humoral and cellular stimulation and long-term impact on patient outcomes. A new dialyzer with a modified membrane surface has been tested for performance and hemocompatibility. Methods: This multicenter, prospective, randomized, cross-over study applied for one week each the new polysulfone-based FX CorAL 600 (Fresenius Medical Care, Bad Homburg, Germany), the polyarylethersulfone-based Polyflux 170H (Baxter Healthcare Corporation, Deerfield, IL, USA) and the cellulose-triacetate-based SureFluxTM 17UX (Nipro Medical Europe, Mechelen, Belgium) to assess non-inferiority of removal rate of β2-microglobulin of the FX CorAL 600. Performance was assessed by removal rate and clearance of small and middle molecules. Hemocompatibility was assessed through markers of complement, cell activation, contact activation and coagulation. Results: Of 70 patients, 58 comprised the intention-to-treat population. The removal rate of β2-microglobulin of the FX CorAL 600 was non-inferior to both comparators (P<0.0001 vs SureFluxTM 17UX; P=0.0006 vs Polyflux 170H), and superior to SureFluxTM 17UX. The activation of C3a and C5a with FX CorAL 600 was significantly lower 15 min after treatment start than with SureFluxTM 17UX. The activation of sC5b-9 with FX CorAL 600 was significantly lower over the whole treatment than with SureFluxTM 17UX, and lower after 60 min than with Polyflux 170H. The treatments with FX CorAL 600 were well tolerated. Conclusions: FX CorAL 600 efficiently removed small and middle molecules, showed a favorable hemocompatibility profile and was associated with a low frequency of adverse events in the present study with a limited patient number and follow-up time. Further studies with longer observation times are warranted to provide further evidence supporting the use of the new dialyzer in a wide range of therapeutic options and long-term treatments of hemodialysis patients to minimize the potential impact on inflammatory processes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 70%

Performance and Hemocompatibility of a Novel Polysulfone Dialyzer: A Randomized Controlled Trial

Ehlerding¹,

Erlenkötter

Gauly

et al. 2021

Kidney360

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“…The better of hemodialysis patients, suggesting a reduced ability of understanding of the biological effects of proinflammathe immune cells of these patients to respond to pathotory cytokines gained over the last decade strongly suplogic stimuli [18,19]. Finally, other authors did not see ports the hypothesis that these soluble mediators may evidence of any production or release of different cytobe involved in the pathogenesis of both acute and chronic kines (TNF-␣, IL-6, and mRNA coding for IL-1␤) by complications of dialysis treatment, including fever, hymonocytes during high-flux bicarbonate hemodialysis, potension, sleep disorders, dialysis-related amyloidosis, neither with complement-activating membranes nor with impaired immunity, bone disease, malnutrition, and anecontaminated dialysate [20]. Because of the great varimia (Table 1).…”

mentioning

confidence: 99%

Clinical relevance of cytokine production in hemodialysis

Pertosa¹,

Grandaliano²,

Gesualdo³

et al. 2000

Kidney International

132

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Clinical relevance of cytokine production in hemodialysis.ates a complex of acute and chronic side effects also Blood-dialyzer interaction in hemodialysis has the potential known as "bioincompatibility phenomena" [4, 5].to activate mononuclear cells leading to the production of Many aspects regarding morbidity and mortality of inflammatory cytokines. The extent of activation is dependent dialysis patients may be related to these cellular events on the dialyzer material used and is considered an index of and, in particular, to the production of cytokines by pebiocompatibility. Cytokines, such as interleukin-1␤ (IL-1␤), tumor necrosis factor-␣ (TNF-␣), and IL-6, may induce an ripheral blood mononuclear cells (PBMCs) [6,7]. Cytoinflammatory state and are believed to play a significant role in kines are a family of pleiotropic polypeptides with a dialysis-related morbidity. The interleukin hypothesis suggests molecular weight ranging from 10 to 45 kD that, prothat the release of proinflammatory cytokines acts as an underduced by different cells in response to inflammatory stimlying pathophysiologic event in hemodialysis-related acute uli, may modulate a variety of functions not only in manifestations, such as fever and hypotension. Nevertheless, a cytokine overproduction may alter sleep pattern in chronic circulating immune cells, but also in mesenchymal, endohemodialyzed patients, thus explaining the presence of sleep thelial, and epithelial cells [8]. There is an increasing disorders in these patients. A potential role of cytokines in body of evidence that the interaction between blood chronic-related morbidity has also been suggested. High levels and dialytic membranes induces the release of several of some inflammatory cytokines are often associated with anemia caused by hyporesponsiveness to erythropoietin. Cytokine cytokines from circulating mononuclear cells, such as production may also play a relevant role in bone remodeling by interleukin-1 (IL-1), IL-6, IL-8, tumor necrosis factor-␣ regulating osteoblast/osteoclast cell functions and parathyroid (TNF-␣), and monocyte chemotactic factor-1 (MCP-1). hormone (PTH). Finally, cytokine release may have a long-The specific action of any of these monocyte-derived term deleterious effect on mortality of uremic patients by altercytokines may be relevant in the pathogenesis of clinical ing immune response and increasing susceptibility to infections. Bioincompatibility of dialytic membranes may also contribute manifestations often observed in end-stage renal disease to malnutrition in dialysis patients by increasing the monocyte (ESRD) patients undergoing chronic hemodialysis [9,10]. release of catabolic cytokines such as TNF-␣ and IL-6. Bioincompatible dialytic treatment may induce an inappropriate monocyte activation and cytokine production, which, in turn, MECHANISMS INVOLVED IN CYTOKINEmay mediate some of the immune and metabolic dysfunction PRODUCTION DURING HEMODIALYSIS associated with hemodialysis. The use of biocompatible dialytic membranes appears to reduce the...

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Cellulose, modified cellulose and synthetic membranes in the haemodialysis of patients with end-stage renal disease

MacLeod

Daly²,

Khan³

et al. 2001

Cochrane Database of Systematic Reviews

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Biocompatibility and Performance of a Modified Cellulosic and a Synthetic High Flux Dialyzer

Cited by 24 publications

References 0 publications

Performance and Hemocompatibility of a Novel Polysulfone Dialyzer: A Randomized Controlled Trial

Performance and Hemocompatibility of a Novel Polysulfone Dialyzer: A Randomized Controlled Trial

Clinical relevance of cytokine production in hemodialysis

Cellulose, modified cellulose and synthetic membranes in the haemodialysis of patients with end-stage renal disease

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