Fp516dialysis Membrane Pore Size Does Not Determine LPS Retention

Hulko, Michael; Gekeler, Alexander; Koch, Ilona; Dietrich, Verena; Krause, Bernd

doi:10.1093/ndt/gfv179.45

Cited by 6 publications

(6 citation statements)

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“…Dialysis fluid quality is a potential safety concern when using more permeable membranes. However, experimental data indicate that adsorption is the main mechanism for retention of bacterial products to synthetic membrane materials [ 47 ] and in vitro data indicate that, for polyarylethersulfone (PAES)/polyvinylpyrrolidone (PVP) membranes, permeability is not a decisive factor for endotoxin retention [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Performance of hemodialysis with novel medium cut-off dialyzers

Kirsch

Lyko

Nilsson

et al. 2016

Nephrol. Dial. Transplant.

177

249

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Background. Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules. Methods. In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments. Results. MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF. Conclusions. MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC.

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Section: Discussionmentioning

confidence: 99%

Performance of hemodialysis with novel medium cut-off dialyzers

Kirsch

Lyko

Nilsson

et al. 2016

Nephrol. Dial. Transplant.

177

249

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“…7 Furthermore, unlike high cut-off membranes, the MWCO of the MCO membrane is slightly lower than that of albumin, preventing albumin loss during dialysis. 8,9 In addition, it allows for exceptional internal filtration without the need for replacement fluid, enabling additional convection during hemodialysis. 9 A1M is a peptide composed of 183 amino acids with a molecular weight of 33000 Da.…”

Section: Introductionmentioning

confidence: 99%

The effect of hemodiafiltration vs. high-flux hemodialysis on alpha 1-microglobulin level and dialysate albumin loss using a dialyzer surface area of 2.6 m²

El‐Sayed

Fathy

Khedr

et al. 2023

EJI

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Dialysis therapy has remarkably evolved through the innovation in dialyzers and hemodialysis modalities, enhancing patients’ quality of life. The efficacy of dialysis can be determined by measuring the reduction ratio (RR) of middle molecules, such as alpha 1-microglobulin (A1M). In this study, we tested a high-flux dialyzer, BIOPURE (Biorema) 260 HF, with a surface area (SA) of 2.6 m2, in terms of A1M removal and concurrent albumin loss in dialysate while receiving high-flux hemodialysis (HF-HD) and post-dilution online hemodiafiltration (OL-HDF). This crossover study comprised 25 patients who received a session of HF-HD using the BIOPURE (Biorema) 260 H, followed by a session of post-dilution OL-HDF. A washout period of 2 weeks was instilled between the two sessions, during which the patients received HF-HD using high-flux dialyzers (maximum SA 2.0 m2). All patients’ hourly dialysate albumin and pre/post dialysis concentrations of A1M were measured. The dialyzer used in this study resulted in significantly higher A1M RR of 41.9±7.93% with HDF than with HF-HD 27.12±7.65% (p<0.001), and a median cumulative dialysate albumin loss of 2.97g (IQR 1.98 – 3.37), and 0.67g (IQR 0.49 – 1.13) with HDF and HF-HD, respectively. In conclusion, the dialyzer BIOPURE (Biorema) 260 HF (SA 2.6 m2) is efficient in eliminating A1M, especially with OL-HDF compared to HF-HD, with acceptable albumin loss in the dialysate.

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“…The MWCO of the MCO membrane is slightly lower than that of albumin. Therefore, MWCO exhibits an advantage in preventing the loss of albumin during treatment compared with high cut-off membranes [ 29 , 30 ]. In addition, dialysis with MCO dialyzers provides additional convection during hemodialysis via significant internal filtration without the need for replacement fluid [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Medium Cut-Off Polyarylethersulfone and Polyvinylpyrrolidone Blend Membrane Dialyzers in Hemodialysis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2022

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The use of medium cut-off (MCO) polyarylethersulfone and polyvinylpyrrolidone blend membrane is an emerging mode in hemodialysis. Recent studies have shown that MCO membranes exhibit a middle high molecular weight uremic toxin clearance superior to standard high flux hemodialysis. We conducted a systematic literature review and meta-analysis of randomized controlled trials to investigate whether MCO membranes efficiently increase the reduction ratio of middle molecules, and to explore the potential clinical applications of MCO membranes. We selected articles that compared beta 2-microglobulin (β2M), kappa free light chain (κFLC), lambda free light chain (λFLC), interleukin-6 (IL-6), and albumin levels among patients undergoing hemodialysis. Five randomized studies with 328 patients were included. The meta-analysis demonstrated a significantly higher reduction ratio of serum β2M (p < 0.0001), κFLC (p < 0.0001), and λFLC (p = 0.02) in the MCO group. No significant difference was found in serum IL-6 levels after hemodialysis. Albumin loss was observed in the MCO group (p = 0.04). In conclusion, this meta-analysis study demonstrated the MCO membranes’ superior ability to clear β2M, κFLC, and λFLC. Serum albumin loss is an issue and should be monitored. Further studies are expected to identify whether MCO membranes could significantly improve clinical outcomes and overall survival.

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Fp516dialysis Membrane Pore Size Does Not Determine LPS Retention

Cited by 6 publications

References 0 publications

Performance of hemodialysis with novel medium cut-off dialyzers

Performance of hemodialysis with novel medium cut-off dialyzers

The effect of hemodiafiltration vs. high-flux hemodialysis on alpha 1-microglobulin level and dialysate albumin loss using a dialyzer surface area of 2.6 m²

Effects of Medium Cut-Off Polyarylethersulfone and Polyvinylpyrrolidone Blend Membrane Dialyzers in Hemodialysis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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