Comparison of four medium cut-off dialyzers

Abstract

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.

Reply to “Comparison of four medium cut-off dialyzers”

“…Considering that the values of free λFLC RR varied between 20% and 60% in our study [ 1 ], there were no significant differences in the λFLC RRs between the four MCO dialyzer treatments, and all of them were significantly higher than those obtained with high-flux HD treatments and significantly lower than those obtained with hemodiafiltration. Therefore, λFLC could be considered a good differential marker of dialysis treatment efficacy, as it allows clear discrimination between high-flux HD, MCO dialyzer hemodialysis and high-volume hemodiafiltration treatments.…”

“…We would like to thank Krieter and Wanner for their kind remarks on our recently published study [ 1 ]. The authors have raised some interesting issues, and we are grateful for the opportunity to address them.…”

“…[ 2 ] found a λFLC reduction ratio (RR) of 28 ± 4% with ELISIO HX17 (surface area 1.7 m 2 ) and 39 ± 13% with Theranova 400 (surface area 1.7 m 2 ). Our study of 23 patients [ 1 ] obtained a λFLC RR of 44.0 ± 8.0% with ELISIO HX19 (surface area 1.9 m 2 ) and 48.3 ± 7.4% with Theranova 400. These slightly higher values can be partly explained by differences in the prescription parameters of the dialysis treatment: dialyzer surface area, blood flow (300 vs 439 ± 26 mL/min) and dialysis duration (240 vs 288 ± 17 min).…”

Comparison of four medium cut-off dialyzers

“…In an interesting clinical study, Maduell et al . compared the treatment efficacy of four recently available MCO dialyzers, high-flux hemodialysis and hemodiafiltration [ 1 ]. They did not identify considerable differences in lambda free light chain (λFLC) removal between the MCO filters; the reduction ratios averaged from 44.0% to 50.9%.…”

“…With a molecular weight of 45 kDa and a Stokes’ radius of 2.8 nm, the λFLC dimer is a biomarker of particular interest, because it is ideally suited for the characterization of the typical cut-off range of MCO dialysis membranes [ 2 ]. Due to the rather high serum concentrations measured and the scarce information provided in the methods, it must be questioned whether the λFLC determinations used by the authors were based on the immunonephelometric N-Latex assay with monoclonal antibodies (BNII analyzer, Siemens Healthineers) [ 1 ]. λFLC concentrations determined with this assay are considerably higher than those derived from an assay that employs polyclonal antibodies (Freelite™) [ 3 , 4 ].…”