Effect of high‐flux dialysis on the anaemia of haemodialysis patients

Abstract

This study showed no difference in haemoglobin level increase between patients treated for 3 months with a high-flux biocompatible membrane in comparison with those treated with a standard membrane. When patients are highly selected, adequately dialysed, and have no iron or vitamin depletion, the effect of a high-flux membrane is much less than might be expected from the results of uncontrolled studies.

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD

“…Our findings are in line with the results of a shorter-term study from Locatelli and colleagues (12). In that multicenter randomized, controlled trial the investigators could not detect differences in hemoglobin levels or ESA doses between patients treated for 3 months with a high-flux membrane compared with those treated with a standard (i.e., low-flux) membrane (12).…”

“…In that multicenter randomized, controlled trial the investigators could not detect differences in hemoglobin levels or ESA doses between patients treated for 3 months with a high-flux membrane compared with those treated with a standard (i.e., low-flux) membrane (12). As was seen in our study, patients in the study by Locatelli and colleagues were all adequately dialyzed and had no iron deficiency.…”

“…These "high-flux" membranes also eliminate molecules of medium molecular weight that accumulate in renal failure and that have been suggested as causing adverse effects on erythropoiesis (9). However, various clinical studies aiming to demonstrate the superiority of high-flux over low-flux membranes for renal anemia have delivered conflicting results (9)(10)(11)(12)(13). Consequently, it remains unclear whether and how the removal of higher-molecular-weight molecules would benefit hemoglobin levels.…”

The Evolving Patterns of Uremia: Unmet Clinical Needs in Dialysis

“…However, clearance of middle and large molecules is considerably inadequate in HDF or OL-HDF. These middle and large molecular uremic toxins include protein-bound toxins or toxins whose molecular weight exceeds the pore size of the membrane used, say, β-2 microglobulin (β2M), tumor necrosis factor (TNF)-α, interleukins, complement factor D, and other pro-inflammatory factors [7,8,10,11] .…”

Controversies in renal anemia management

“…53 Evidence of the clinical validation of the role of uremic inhibitors of erythropoiesis comes from numerous reports that inadequate dialysis in patients sustained by either HD or continuous ambulatory peritoneal dialysis was associated with a poor response to EPO (persistently low Hb). [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] Several studies have also shown that Hb levels increased with an increase in HD dose in EPO-treated patients with low Hb. 26,62,69,74,75 In fact, the strong relation between Hb and adequacy of dialysis in patients with ESRD treated with EPO has been corroborated by analyses of pooled data at both the dialysis facility and the ESRD Network levels.…”