Comparison of hemodialysis using a medium cutoff dialyzer versus hemodiafiltration : A controlled cross-over study
(2020) In International Journal of Nephrology and Renovascular Disease 13. p.273-280- Abstract
Purpose: Conventional hemodialysis (HD) treatment has an acceptable removal of small uremic molecules, but so-called middle molecules in the range of 0.5-60 kDa are poorly cleared with HD compared to a native kidney, which may contribute to morbidity in the dialysis population. Hemodiafiltration (HDF) has a better removal of middle molecules compared to HD but is technically demanding and requires well-functioning dialysis access. The newly introduced medium cutoff (MCO) filters have been developed to enhance middle molecule clearance in HD-mode. The aim of this study was to compare reduction ratios (RRs) of molecules with different molecular weights (0.06-150 kDa) during dialysis with MCO dialyzer (used in HD-mode) compared to... (More)
Purpose: Conventional hemodialysis (HD) treatment has an acceptable removal of small uremic molecules, but so-called middle molecules in the range of 0.5-60 kDa are poorly cleared with HD compared to a native kidney, which may contribute to morbidity in the dialysis population. Hemodiafiltration (HDF) has a better removal of middle molecules compared to HD but is technically demanding and requires well-functioning dialysis access. The newly introduced medium cutoff (MCO) filters have been developed to enhance middle molecule clearance in HD-mode. The aim of this study was to compare reduction ratios (RRs) of molecules with different molecular weights (0.06-150 kDa) during dialysis with MCO dialyzer (used in HD-mode) compared to online-hemodiafiltration (ol-HDF) treatment with a conventional high-flux dialyzer. Patients and Methods: This is a prospective controlled single-center cross-over study, including 16 patients in Malmo, Sweden. All patients had ongoing post-dilution ol-HDF treatment before the study. The study compared reduction ratios of small-, middle-, and large-sized molecules during a single 4h dialysis treatment with post-dilution ol-HDF (Polyflux 210H) to a 4h dialysis treatment with MCO dialyzer (Theranova 500) in HDmode. Between treatments, the patients had a washout period of at least two weeks of their ordinary HDF treatment to reach their ordinary steady state. Results: Ol-HDF had significantly higher RR for cystatin C (13 kDa), compared to MCO (RR 68.1 vs 65.8, p=0.003), during a 4h dialysis treatment (mean convection volume of 24.5 L for HDF, and mean Qb of 324 mL/min for HDF and 323 mL/min for MCO). There was no significant difference in the RR for other middle molecules, or for smaller or larger molecules. Conclusion: Overall, the RRs were comparable for ol-HDF and MCO-HD. There was a slightly higher RR of cystatin C (a small middle molecule) for HDF compared to MCO but no difference in other measured molecules.
(Less)
- author
- Lindgren, Anna LU ; Fjellstedt, Erik LU and Christensson, Anders LU
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Chronic hemodialysis, Dialysis, Hemodiafiltration, Hemodialysis, MCO, Uremic toxins
- in
- International Journal of Nephrology and Renovascular Disease
- volume
- 13
- pages
- 8 pages
- publisher
- Dove Medical Press Ltd.
- external identifiers
-
- pmid:33149656
- scopus:85095453104
- ISSN
- 1178-7058
- DOI
- 10.2147/IJNRD.S263110
- language
- English
- LU publication?
- yes
- id
- 68d833c9-fc78-4ffc-9f70-12046ebe74f7
- date added to LUP
- 2020-11-17 13:22:10
- date last changed
- 2024-04-03 15:04:56
@article{68d833c9-fc78-4ffc-9f70-12046ebe74f7,
abstract = {{<p>Purpose: Conventional hemodialysis (HD) treatment has an acceptable removal of small uremic molecules, but so-called middle molecules in the range of 0.5-60 kDa are poorly cleared with HD compared to a native kidney, which may contribute to morbidity in the dialysis population. Hemodiafiltration (HDF) has a better removal of middle molecules compared to HD but is technically demanding and requires well-functioning dialysis access. The newly introduced medium cutoff (MCO) filters have been developed to enhance middle molecule clearance in HD-mode. The aim of this study was to compare reduction ratios (RRs) of molecules with different molecular weights (0.06-150 kDa) during dialysis with MCO dialyzer (used in HD-mode) compared to online-hemodiafiltration (ol-HDF) treatment with a conventional high-flux dialyzer. Patients and Methods: This is a prospective controlled single-center cross-over study, including 16 patients in Malmo, Sweden. All patients had ongoing post-dilution ol-HDF treatment before the study. The study compared reduction ratios of small-, middle-, and large-sized molecules during a single 4h dialysis treatment with post-dilution ol-HDF (Polyflux 210H) to a 4h dialysis treatment with MCO dialyzer (Theranova 500) in HDmode. Between treatments, the patients had a washout period of at least two weeks of their ordinary HDF treatment to reach their ordinary steady state. Results: Ol-HDF had significantly higher RR for cystatin C (13 kDa), compared to MCO (RR 68.1 vs 65.8, p=0.003), during a 4h dialysis treatment (mean convection volume of 24.5 L for HDF, and mean Qb of 324 mL/min for HDF and 323 mL/min for MCO). There was no significant difference in the RR for other middle molecules, or for smaller or larger molecules. Conclusion: Overall, the RRs were comparable for ol-HDF and MCO-HD. There was a slightly higher RR of cystatin C (a small middle molecule) for HDF compared to MCO but no difference in other measured molecules.</p>}},
author = {{Lindgren, Anna and Fjellstedt, Erik and Christensson, Anders}},
issn = {{1178-7058}},
keywords = {{Chronic hemodialysis; Dialysis; Hemodiafiltration; Hemodialysis; MCO; Uremic toxins}},
language = {{eng}},
pages = {{273--280}},
publisher = {{Dove Medical Press Ltd.}},
series = {{International Journal of Nephrology and Renovascular Disease}},
title = {{Comparison of hemodialysis using a medium cutoff dialyzer versus hemodiafiltration : A controlled cross-over study}},
url = {{http://dx.doi.org/10.2147/IJNRD.S263110}},
doi = {{10.2147/IJNRD.S263110}},
volume = {{13}},
year = {{2020}},
}