Switch from conventional to high-flux membrane reduces the risk of carpal tunnel syndrome and mortality of hemodialysis patients

Koda, Yutaka; Nishi, Shinichi; Miyazaki, Shigeru; Haginoshita, Susumu; Sakurabayashi, Tai; Suzuki, Masashi; Sakai, Shinji; Yuasa, Yasuko; Hirasawa, Yoshihei; Nishi, T.

doi:10.1038/ki.1997.434

Cited by 212 publications

(137 citation statements)

References 19 publications

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“…63 Since both hemofiltration and hemodiafiltration are able to remove b2M significantly, some studies have reported a lower incidence of CTS in patients treated with these two dialysis methods; however, a clear benefit of these two dialytic techniques versus biocompatible high-flux HD performed at high blood flow rate has not been demonstrated. 64,65 In order to achieve a better clearance of b2M, it is certainly useful to increase the duration and frequency of dialysis; thus, the onset and development of DRA is delayed. This observation could justify why either nocturnal or short daily HD is better than conventional thrice-weekly dialysis to ameliorate DRA.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Dialysis-related amyloidosis: challenges and solutions

Scarpioni¹,

Ricardi²,

Albertazzi³

et al. 2016

IJNRD

113

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Amyloidosis refers to the extracellular tissue deposition of fibrils composed of lowmolecular-weight subunits of a variety of proteins. These deposits may result in a wide range of clinical manifestations depending upon their type, location, and the amount of deposition. Dialysis-related amyloidosis is a serious complication of long-term dialysis therapy and is characterized by the deposition of amyloid fibrils, principally composed of b2 microglobulins (b2M), in the osteoarticular structures and viscera. Most of the b2M is eliminated through glomerular filtration and subsequent reabsorption and catabolism by the proximal tubules. As a consequence, the serum levels of b2M are inversely related to the glomerular filtration rate; therefore, in end-stage renal disease patients, b2M levels increase up to 60-fold. Serum levels of b2M are also elevated in several pathological conditions such as chronic inflammation, liver disease, and above all, in renal dysfunction. Retention of amyloidogenic protein has been attributed to several factors including type of dialysis membrane, prolonged uremic state and/or decreased diuresis, advanced glycation end products, elevated levels of cytokines and dialysate. Dialysis treatment per se has been considered to be an inflammatory stimulus, inducing cytokine production (such as interleukin-1, tumor necrosis factor-α, interleukin-6) and complement activation. The released cytokines are thought to stimulate the synthesis and release of b2M by the macrophages and/or augment the expression of human leukocyte antigens (class I), increasing b2M expression. Residual renal function is probably the best determinant of b2M levels. Therefore, it has to be maintained as long as possible. In this article, we will focus our attention on the etiology of dialysis-related amyloidosis, its prevention, therapy, and future solutions.

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Section: Prevention and Treatmentmentioning

confidence: 99%

Dialysis-related amyloidosis: challenges and solutions

Scarpioni¹,

Ricardi²,

Albertazzi³

et al. 2016

IJNRD

113

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“…16,17 The results of previous studies that evaluated the possible clinical advantages of HDF in comparison with HD are not consistent, and it is not possible to make any precise conclusion out of them. [17][18][19][20][21] Compared with low-flux dialysis, high-flux HD might have a beneficial effect on mortality and clinical outcomes in the patients [22][23][24][25][26][27] or not. 28 The use of synthetic high-flux membranes should be considered to delay the longterm complication of HD therapy: amyloidosis, hyperphosphatemia, cardiovascular risk, and anemia.…”

Section: Introductionmentioning

confidence: 99%

Influence of Dialysis Modality and Membrane Flux on Quality of Life in Hemodialysis Patients

Knežević¹,

Djordjević²,

Radovanovic-Velickovic³

et al. 2012

Renal Failure

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Background: The quality of life in patients undergoing hemodialysis is significantly disturbed. There are data that hemodiafiltration (HDF) may be more effective than conventional hemodialysis in the removal of uremic toxins and may reduce frequency and severity of intradialytic and postdialysis adverse symptoms in patients. Also, some researchers suggest advantages of using high-flux membranes compared with low-flux. Objective: The aim of this study was to examine whether hemodialysis modality and membrane flux, independent of membrane biocompatibility, make differences in quality of life in patients. Methods: In our cross-sectional study, we evaluated 124 patients who were divided, based on therapy, into three groups: online HDF, high-flux hemodialysis, and low-flux hemodialysis. Data were collected using the Short Form-36 questionnaire combined with special questionnaire, which included demographic and clinically related questions. Results: Health-related quality of life was better in patients on HDF compared with patients on hemodialysis, especially compared with low-flux hemodialysis patients in most of the scales and in both dimensions: physical component scale and mental component scale. There were no statistically significant differences in Short Form-36 domains between high-flux hemodialysis and low-flux hemodialysis. Conclusion: Our data suggest the potential advantages of HDF with regard to influence on quality of life, which is sufficient to justify further research in prospective and longitudinal study design.

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“…Most of these reports have shown that ultrapure dialysate use might lead to better outcomes. [14][15][16][17] However, no study has investigated the effect on survival in a randomized, controlled manner. This study showed no difference between the ultrapure and standard dialysate groups in the primary analysis.…”

Section: Discussionmentioning

confidence: 99%

“…12 Ultrapure dialysis fluid has also been associated with less inflammation, resulting in clinically relevant improvements, including amelioration of erythropoietin response, 13 better nutritional status, 14,15 and reduction in the incidence of b 2 -microglobulin amyloidosis. 16 Although preliminary reports suggested lower cardiovascular morbidity with the use of ultrapure dialysis fluid, 17 no randomized and controlled trial has been performed addressing hard clinical outcomes.…”

mentioning

confidence: 99%

The Impact of Membrane Permeability and Dialysate Purity on Cardiovascular Outcomes

Aşçı

Töz

Özkahya

et al. 2013

Journal of the American Society of Nephrology

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The effects of high-flux dialysis and ultrapure dialysate on survival of hemodialysis patients are incompletely understood. We conducted a randomized controlled trial to investigate the effects of both membrane permeability and dialysate purity on cardiovascular outcomes. We randomly assigned 704 patients on three times per week hemodialysis to either high-or low-flux dialyzers and either ultrapure or standard dialysate using a two-by-two factorial design. The primary outcome was a composite of fatal and nonfatal cardiovascular events during a minimum 3 years follow-up. We did not detect statistically significant differences in the primary outcome between high-and low-flux (HR=0.73, 95% CI=0.49 to 1.08, P=0.12) and between ultrapure and standard dialysate (HR=0.90, 95% CI=0.61 to 1.32, P=0.60). Posthoc analyses suggested that cardiovascular event-free survival was significantly better in the high-flux group compared with the low-flux group for the subgroup with arteriovenous fistulas, which constituted 82% of the study population (adjusted HR=0.61, 95% CI=0.38 to 0.97, P=0.03). Furthermore, high-flux dialysis associated with a lower risk for cardiovascular events among diabetic subjects (adjusted HR=0.49, 95% CI=0.25 to 0.94, P=0.03), and ultrapure dialysate associated with a lower risk for cardiovascular events among subjects with more than 3 years of dialysis (adjusted HR=0.55, 95% CI=0.31 to 0.97, P=0.04). In conclusion, this trial did not detect a difference in cardiovascular event-free survival between flux and dialysate groups. Posthoc analyses suggest that high-flux hemodialysis may benefit patients with an arteriovenous fistula and patients with diabetes and that ultrapure dialysate may benefit patients with longer dialysis vintage.

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Switch from conventional to high-flux membrane reduces the risk of carpal tunnel syndrome and mortality of hemodialysis patients

Cited by 212 publications

References 19 publications

Dialysis-related amyloidosis: challenges and solutions

Dialysis-related amyloidosis: challenges and solutions

Influence of Dialysis Modality and Membrane Flux on Quality of Life in Hemodialysis Patients

The Impact of Membrane Permeability and Dialysate Purity on Cardiovascular Outcomes

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