2017
DOI: 10.1159/000479266
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Large Middle Molecule and Albumin Removal: Why Should We Not Rest on Our Laurels?

Abstract: Large middle molecules (LMM) are an important subclass of uremic toxins. Many of them have been linked with poor outcomes in hemodialysis (HD) patients. The onset of highflux membranes and convective techniques allowed to dramatically improve their clearance but without a clear and undebatable reduction of mortality in HD patients. Despite the real effect on the removal of selected toxins, little is known about the influence of modern HD techniques on the global removal of uremic toxins. Mostly explained by a … Show more

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Cited by 9 publications
(9 citation statements)
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“…Improvements are attributed to greater removal of middle molecules using HDF. However, these membranes and/or techniques, in addition to increasing the cost burden [ 57 , 59 , 60 , 61 , 62 ], induce greater albumin losses of 3.5 to 9.0 g per HD session [ 63 , 64 ], along with involuntary removal of vitamins, larger protein molecules, and lipids [ 62 ].…”
Section: Iatrogenic Factors Of Malnutritionmentioning
confidence: 99%
See 1 more Smart Citation
“…Improvements are attributed to greater removal of middle molecules using HDF. However, these membranes and/or techniques, in addition to increasing the cost burden [ 57 , 59 , 60 , 61 , 62 ], induce greater albumin losses of 3.5 to 9.0 g per HD session [ 63 , 64 ], along with involuntary removal of vitamins, larger protein molecules, and lipids [ 62 ].…”
Section: Iatrogenic Factors Of Malnutritionmentioning
confidence: 99%
“…A major aim of dialysis therapy is to remove uremic waste products [ 57 , 102 ]. However, dialysis only reduces uremic burden through partial removal of uremic solutes [ 103 ].…”
Section: Iatrogenic Factors Of Malnutritionmentioning
confidence: 99%
“…Further studies are needed to explore the effect of HDx on the appetite and nutritional status of patients with HD. Moreover, albumin leak could be considered as positive as it could enhance protein-bound uraemic toxin removal and clearance of toxic modified forms of albumin [ 11 , 12 ].…”
Section: Unmet Needs: Is There a Place For Hdx?mentioning
confidence: 99%
“…The algorithm proposed is based on some arbitrary, or unproven assumptions: Albumin is the most relevant prognostic marker in both HDF and HD [ 70 , 71 , 72 , 73 ]; Albumin loss is non-selective, and low serum albumin levels have to be avoided [ 74 , 75 , 76 , 77 , 78 ] (i.e., “toxic albumin”, is not selectively lost; toxic albumin is albumin-linked to uremic toxins, for which loss should be promoted according to some authors [ 73 , 74 ]; Different dialyzers in the same category are equivalent (high-, medium- or low-flux) in terms of performance and albumin leakage (while this is not entirely true, a detailed discussion is beyond the scope of this review); Loss of albumin is higher in the first minutes of HDF, supporting the choice of low-permeability membranes in the case of more frequent dialysis [ 74 ]; Loss of albumin is also a marker of loss of other potentially useful nutrients, including vitamins; such a loss may contribute to malnutrition; Adsorption by dialysis membranes is not a relevant element in the removal of uremic toxins; if present, it is similar in similar categories of dialyzers [ 78 ]. …”
Section: Arbitrary (Or Unproven) Assumptionsmentioning
confidence: 99%
“…Albumin loss is non-selective, and low serum albumin levels have to be avoided [ 74 , 75 , 76 , 77 , 78 ] (i.e., “toxic albumin”, is not selectively lost; toxic albumin is albumin-linked to uremic toxins, for which loss should be promoted according to some authors [ 73 , 74 ];…”
Section: Arbitrary (Or Unproven) Assumptionsmentioning
confidence: 99%