Expanded Haemodialysis as a Current Strategy to Remove Uremic Toxins

Ciceri, Paola; Cozzolino, Mario

doi:10.3390/toxins13060380

Cited by 18 publications

(19 citation statements)

References 64 publications

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“…Hemodialysis (HD) is the most popular mode among renal replacement therapy modalities in end-stage kidney disease (ESKD) patients. Uremic toxins accumulated in ESKD patients comprise small-molecule (<500 Da), middle-molecule (>500 Da) which are composed of small DOI: 10.1159/000521886 middle-molecule (<25,000 Da) and large middle-molecule (≥25,000 Da) uremic toxins, and protein-bound uremic toxins (PBUTs) [1][2][3][4]. The current standard HD can excellently remove small-molecule uremic toxins, and this occurs mainly via diffusion process.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness between Expanded Hemodialysis (Hemodialysis Using a Medium Cut-Off Dialyzer) and Mixed-Dilution Online Hemodiafiltration Using a High-Flux Dialyzer in Removing Middle-Molecule Uremic Toxins

et al. 2022

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Introduction: Expanded hemodialysis (HD using a medium cut-off dialyzer [HD + MCO]) provides comparable or better removal of various uremic toxins, particularly large middle-molecule uremic toxins, than post-dilution online hemodiafiltration (olHDF). Uremic toxin-removing effectiveness between HD + MCO and mixed-dilution olHDF, one of the currently most efficient olHDF modalities, has not been assessed. Method: This randomized controlled trial was conducted in 14 prevalent thrice-a-week HD patients with blood flow rate above 400 mL/min. The patients were randomized into two sequences of 2-week treatment periods of HD + MCO and later mixed-dilution olHDF or vice versa. The reduction ratio (RR) values of small-molecule as well as middle-molecule uremic toxins and protein-bound uremic toxins were measured at baseline and at the end of the treatment. Results: When compared with mixed-dilution olHDF, HD + MCO provided slightly lower β2M RR, but the value was still higher than 75%; showed similar κFLC RR, IS RR, and URR; and yielded significantly higher RR values of α1M (p < 0.001) and λFLC (p < 0.001). Despite higher albumin loss in HD + MCO, the serum albumin levels at the end of the study were comparable between both groups. Conclusion: Expanded HD (HD + MCO) provided similar effectiveness in removing various uremic toxins and could exhibit greater removal of large middle-molecule uremic toxins, such as α1M and λFLC. Expanded HD can be used as an effective alternative option for mixed-dilution olHDF.

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Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness between Expanded Hemodialysis (Hemodialysis Using a Medium Cut-Off Dialyzer) and Mixed-Dilution Online Hemodiafiltration Using a High-Flux Dialyzer in Removing Middle-Molecule Uremic Toxins

et al. 2022

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“…All the cytokines and chemokines dosed in our population have a molecular weight between 15 and 50 KDa, thus being middle molecules (MM) accordingly with a recent classification [ 42 ]. Over the past few years, new dialytic membranes are available to better remove MM, the medium cut-off membranes with the technique of expanded hemodialysis [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Cytokine and Chemokine Retention Profile in COVID-19 Patients with Chronic Kidney Disease

Ciceri

Bono

Magagnoli

et al. 2022

Toxins

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Chronic kidney disease (CKD) patients are more susceptible to infections compared to the general population. SARS-CoV-2 virus pathology is characterized by a cytokine storm responsible for the systemic inflammation typical of the COVID-19 disease. Since CKD patients have a reduced renal clearance, we decided to investigate whether they accumulate harmful mediators during the COVID-19 disease. We conducted a retrospective study on 77 COVID-19 hospitalized subjects in the acute phase of the illness. Thirteen different cytokines were assessed in plasma collected upon hospitalization. The patients were divided into three groups according to their estimated glomerular filtration rate, eGFR < 30 (n = 23), 30 < eGFR < 60 (n = 33), eGFR > 60 mL/min (n = 21). We found that Tumor Necrosis Factor α and its receptors I and II, Interleukin-7, Leukemia Inhibitory Factor, FAS receptor, Chitinase 3-like I, and the Vascular Endothelial Growth Factor showed an increased accumulation that negatively correlate with eGFR. Moreover, non-survivor patients with an impaired kidney function have significantly more elevated levels of the same mediators. In conclusion, there is a tendency in COVID-19 ESRD patients to accumulate harmful cytokines. The accumulation seems to associate with mortality outcomes and may be due to reduced clearance but also to increased biosynthesis in most severe cases.

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“…Low-flux hemodialysis, as the traditional mode of dialysis in the past decades, provides efficient clearance of small water-soluble molecules, such as creatinine and urea [ 12 ], but negligible removal of middle molecules and protein-bound uremic toxins [ 13 , 14 ]. Compared with low-flux hemodialysis membranes, high-flux membranes have a higher UF coefficient, resulting from increased hydraulic permeability.…”

Section: Introductionmentioning

confidence: 99%

Effects of Expanded Hemodialysis with Medium Cut-Off Membranes on Maintenance Hemodialysis Patients: A Review

Zhang

Yang

et al. 2022

Membranes

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Kidney failure is associated with high morbidity and mortality. Hemodialysis, the most prevalent modality of renal replacement therapy, uses the principle of semipermeable membranes to remove solutes and water in the plasma of patients with kidney failure. With the evolution of hemodialysis technology over the last half century, the clearance of small water-soluble molecules in such patients is adequate. However, middle molecules uremic toxins are still retained in the plasma and cause cardiovascular events, anemia, and malnutrition, which significantly contribute to poor quality of life and high mortality in maintenance hemodialysis patients. A new class of membrane, defined as a medium cut-off (MCO) membrane, has emerged in recent years. Expanded hemodialysis with MCO membranes is now recognized as the artificial kidney model closest to natural kidney physiology. This review summarizes the unique morphological characteristics and internal filtration–backfiltration mechanism of MCO membranes, and describes their effects on removing uremic toxins, alleviating inflammation and cardiovascular risk, and improving quality of life in maintenance hemodialysis patients.

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Expanded Haemodialysis as a Current Strategy to Remove Uremic Toxins

Cited by 18 publications

References 64 publications

Comparative Effectiveness between Expanded Hemodialysis (Hemodialysis Using a Medium Cut-Off Dialyzer) and Mixed-Dilution Online Hemodiafiltration Using a High-Flux Dialyzer in Removing Middle-Molecule Uremic Toxins

Comparative Effectiveness between Expanded Hemodialysis (Hemodialysis Using a Medium Cut-Off Dialyzer) and Mixed-Dilution Online Hemodiafiltration Using a High-Flux Dialyzer in Removing Middle-Molecule Uremic Toxins

Cytokine and Chemokine Retention Profile in COVID-19 Patients with Chronic Kidney Disease

Effects of Expanded Hemodialysis with Medium Cut-Off Membranes on Maintenance Hemodialysis Patients: A Review

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