Removal of middle molecules with medium cutoff dialyzer in patients on short frequent hemodialysis

Abstract

Introduction: Medium cutoff (MCO) membranes for hemodialysis (HD) remove more effectively large middle molecules than high-flux (HF) membranes. In patients on in-center short frequent HD regimen (5 sessions per week, 2 hours and 30 minutes per session) the effect of MCO on middle weight uremic toxins has not been elucidated. Methods: This retrospective study included 15 patients previously performing short frequent HD with HF dialyzer (HF-HD), that were switched to short frequent HD with MCO dialyzer (MCO-HD) for 2 months, and returned to HF-HD. The primary endpoint was the predialysis concentration of α1-acid glycoprotein during the different study phases. Secondary endpoints were predialysis concentration of other middle molecules, albumin, and assessment of the quality of life using the 36-item short-form health survey (SF-36). Findings: During MCO-HD phase there was a reduction in mean ± SD α1-acid glycoprotein concentration (98.71 ± 25.2 vs. 88.6 ± 24.6 mg/dL, P = 0.107), followed by an increment 2 months after returning to HF-HD (89.18 ± 26.12 vs. 97.33 ± 31.29 mg/dL, P = 0.002); however, only the second variation was statistically significant. MCO-HD provided lower median predialysis concentration of prolactin (16 [10.2-25.6] vs. 14.1 [11.7-34.8] ng/mL, P = 0.036). Single-pool Kt/V, standard Kt/V, predialysis β2-microglobulin, myoglobin, and SF-36 questionnaire remained stable during the first two phases (pre-MCO and MCO). β2-Microglobulin increased in the post-MCO phase (20.02 ± 8.14 vs. 21.27 ± 7.64 μg/mL, P = 0.000). Mean predialysis concentration of albumin reduced significantly from pre-MCO vs. MCO phases (39.9 ± 3.7 vs. 38.3 ± 3.3 g/L, P = 0.020

Expanded Haemodialysis as a Current Strategy to Remove Uremic Toxins

“…Thus, MCO seems to improve iron metabolism, and the authors demonstrate that this effect is independent by hepcidin. Nevertheless, no effect on ESA dose was found in other two studies [17,19]. The general oxidative stress and inflammatory status of patients dialyzed by MCO compared with LF and HF was also evaluated [49].…”

Disruptive technologies for hemodialysis: medium and high cutoff membranes. Is the future now?

“…The concern about albumin leakage has been extensively explored. It is noteworthy that in clinical studies that applied the membrane for three months or less, albumin pre-dialysis concentration was indeed reduced when compared to baseline after the intervention [30][31][32][33][34] . This finding was challenged by two multicenter trials; one was a single-arm study that applied the MCO membrane for six months in patients (n=87) previously on HF-HD regimen 35 .…”

Disruptive technologies for hemodialysis: medium and high cutoff membranes. Is the future now?

“…The concern about albumin leakage has been extensively explored. It is noteworthy that in clinical studies that applied the membrane for three months or less, albumin pre-dialysis concentration was indeed reduced when compared to baseline after the intervention 30 - 34 . This finding was challenged by two multicenter trials; one was a single-arm study that applied the MCO membrane for six months in patients (n=87) previously on HF-HD regimen 35 .…”