Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode

Bolton, Stephanie; Gair, Rachel; Nilsson, Lars‐Göran; Matthews, Michael; Stewart, Louanne; McCullagh, Natasha

doi:10.2147/prom.s325016

Cited by 12 publications

(11 citation statements)

References 39 publications

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“…We included 26 studies in this review of biomarkers, 15-40 excluding 5 reports of exclusively clinical outcomes. 41-45 Groupings of related citations are in Appendix D.…”

Section: Resultsmentioning

confidence: 99%

Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on Biomarkers: A Systematic Review and Meta-Analysis

Kandi

Brignardello‐Petersen

Couban

et al. 2022

Can J Kidney Health Dis

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Background: Medium cut-off (MCO) membranes enhance large middle-molecule clearance while selectively retaining molecules >45 000 Da. Objectives: We undertook a systematic review and meta-analysis comparing the effects of MCO versus high-flux membranes on biomarkers. Methods: We searched MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science from January 2015 to July 2020, and gray literature sources from 2017. We included randomized (RS) and nonrandomized studies (NRS) comparing MCO and high-flux membranes in adults (>18 years) receiving maintenance hemodialysis. We performed study selection, data extraction, and quality appraisals in duplicate and used the Grading of Recommendations Assessment, Development, and Evaluation framework. Outcomes included solute removal (plasma clearance or dialysate quantitation), reduction ratios, and predialysis serum concentrations for a range of prespecified large middle molecules. Results: We identified 26 eligible studies (10 RS and 16 NRS; N = 1883 patients; patient-years = 1366.3). The mean difference (MD) for albumin removal was 2.31 g per session (95% confidence interval [CI], 2.79 to 1.83; high certainty), with a reduction in predialysis albumin of −0.12 g/dl (95% CI, −0.16 to −0.07; I2 = 0%; high certainty) in the first 24 weeks, returning to normal (MD = −0.02 g/dl, 95% CI, −0.07 to −0.03; I2 = 56%; high certainty) after 24 weeks. We also found with high certainty that MCO dialysis resulted in a large increase (standardized mean difference [SMD]> 2.0 for all) in β2-microglobulin, κ- and λ-free light chains, and myoglobin removal, resulting in moderate (SMD > 0.5) to large (SMD > 0.8) reductions in predialysis concentrations for all of these solutes. Medium cut-off dialysis increased the reduction ratio for tumor necrosis factor-alpha (TNF-α) by 7.7% (95% CI, 4.7 to 10.6; moderate certainty), and reduced predialysis TNF-α by SMD −0.48 (95% CI, −0.91 to −0.04; moderate certainty). We found with moderate certainty that MCO dialysis had little to no effect on predialysis interleukin-6 (IL-6) plasma concentrations. Medium cut-off dialysis reduced mRNA expression of TNF-α and IL-6 in peripheral leukocytes by MD −15% (95% CI, −19.6 to −10.4; moderate certainty) and −8.8% (95% CI, −10.2 to −7.4; moderate certainty), respectively. Conclusion: Medium cut-off dialysis increases the clearance of a wide range of large middle molecules and likely reduces inflammatory mediators with a concomitant transient reduction in serum albumin concentration. The net effect of MCO dialysis on large middle molecules could translate into important clinical effects.

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“…We included 26 studies in this review of biomarkers, 15-40 excluding 5 reports of exclusively clinical outcomes. 41-45 Groupings of related citations are in Appendix D.…”

Section: Resultsmentioning

confidence: 99%

Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on Biomarkers: A Systematic Review and Meta-Analysis

Kandi

Brignardello‐Petersen

Couban

et al. 2022

Can J Kidney Health Dis

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“… 38 Six were abstracts, 29 , 30 , 32 , 34 , 37 and the remaining 16 were full texts, one of which was a manuscript under review. 31 Theranova was the only MCO membrane identified in our search. Details of patient, study design, and intervention characteristics are given in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The 22 included studies comprised 6 randomized studies, [20][21][22][23][24][25][26] including 2 parallel-arm [20][21][22] and 4 crossover trials. [23][24][25][26] Among the nonrandomized studies, 2 were cohort studies 27,28 and the remainder used before-after [16][17][18][29][30][31][32][33][34][35][36][37] or crossover designs. 38 Six were abstracts, 29,30,32,34,37 and the remaining 16 were full texts, one of which was a manuscript under review.…”

Section: Study Characteristicsmentioning

confidence: 99%

Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis

Kandi

Brignardello‐Petersen

Couban

et al. 2022

Can J Kidney Health Dis

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Background: A novel medium cut-off (MCO) dialyzer (Theranova, Baxter Healthcare, Deerfield, IL, USA) enhances large middle molecule clearance while retaining selectivity for molecules >45 000 Da. Objective: We undertook a systematic review and meta-analysis evaluating clinical outcomes with MCO vs high-flux membranes. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science through July 2020, and gray literature sources from 2017. We included randomized (RS) and nonrandomized studies (NRS) comparing MCO and high-flux membranes in adults receiving maintenance hemodialysis. Pairs of reviewers performed study selection, data extraction, and risk of bias assessment in duplicate. We conducted random-effects pairwise meta-analyses to pool results across studies and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence certainty. Results: We identified 22 eligible studies (6 RS, 16 NRS; N = 1811 patients; patient-years = 1546). The MCO dialyzer improved (estimate; 95% confidence interval [CI]; certainty rating) quality of life (mean difference [MD] = 16.7/100 points; 6.9 to 26.4; moderate), Kidney Disease Quality of Life Instrument (KDQOL) subscales—burden (MD = 4.0; 1.1 to 6.9; moderate) and effects (MD = 5.4; 3.2 to 7.6; moderate), pruritus (MD = −4.4; −7.1 to −1.7; moderate), recovery time (MD = −420 minutes; −541 to −299; high), and restless legs syndrome (odds ratio = 0.39; 0.29 to 0.53; moderate). There was little to no difference in all-cause mortality (risk difference = −0.4%; −2.8 to 2.1; moderate) and serious adverse events (rate ratio = 0.63; 0.38 to 1.04; low). MCO dialysis reduced hospitalization (rate ratio = 0.48; 0.27 to 0.84; low), infection (rate ratio = 0.38; 0.17 to 0.85; moderate), hospitalization days (MD = −1.5 days; 95% CI, −2.22 to −0.78; moderate), erythropoiesis resistance index (MD = −2.92 U/kg/week/g/L; 95% CI, −4.25 to −1.6; moderate) and cumulative iron use over 12 weeks (MD = −293 mg; 95% CI, −368 to −218; moderate). We found with low certainty that MCO dialysis had little to no effect on KDQOL symptoms/problem list, pain, and physical health and moderate certainty that MCO dialysis likely has no effect on the KDQOL mental health composite. Conclusions: We found with predominantly moderate certainty that the MCO dialyzer improves several patient-important outcomes with no apparent risks or harms. More definitive studies are needed to better quantify the effects of MCO membranes on mortality, hospitalization, and other rare events.

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“…Bolton et al, when switching from regular high-flux dialysis membrane to medium cutoff (MCO) membrane, and evaluating different symptoms burden by the POS-S Renal total symptom score, showed a decrease at 6 months. The fatigue and lack of energy improved constantly; the percentage of participants scoring its impact as "severe" decreased from 28% at baseline to 16% at 12 months [44]. Other studies using the KDQol-36 and the Edmonton symptom assessment system revised (ESAS-r), did not demonstrate any effect of HDx on QOL [29,47].…”

Section: Quality Of Lifementioning

confidence: 88%

“…Expanded Hemodialysis Therapy: From the Rational to the Delivery DOI: http://dx.doi.org /10.5772/intechopen.110262 Several studies aimed to compare the use of HDx with conventional hemodialysis or HDF in improving QOL parameters, using several scores (LEVIL, KDQOL -SF 36, PROM POS-S Renal Symptom questionnaire and the "Recovery time from last dialysis session) [43,44]. The major items assessed were dialysis symptom index, restless legs syndrome, sleep, energy, and well-being.…”

Section: Quality Of Lifementioning

confidence: 99%

Expanded Hemodialysis Therapy: From the Rational to the Delivery

Kabbali¹,

Chouhani²

2023

Updates on Hemodialysis

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Expanded hemodialysis therapy is a new concept in blood purification technology using a specific membrane with a steep sieving curve characterized by medium membrane cutoff and high retention onset values that are close to but lower than those of albumin. Expanded hemodialysis therapy thereby targets an important pathophysiologic link to many of the sequelae of end-stage renal disease, by improving the clearance of medium to larger-size solutes. The significant internal filtration achieved in these hemodialyzers provides a remarkable convective clearance of medium to high solutes. This therapy does not need specific software or additional complex technology, making its application possible in every setting once the quality of the dialysis fluid is guaranteed to ensure the safe conduct of the dialysis session. The present chapter reviews the rationale for expanded hemodialysis therapy, the potential benefits, and the considerations for prescription and delivery.

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Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode

Cited by 12 publications

References 39 publications

Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on Biomarkers: A Systematic Review and Meta-Analysis

Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on Biomarkers: A Systematic Review and Meta-Analysis

Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis

Expanded Hemodialysis Therapy: From the Rational to the Delivery

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