Abstract

Research Article

Elimination of Medium/High Molecular Weight Solutes. Comparison of High Flow Hemodialysis with Extended Hemodialysis

Manuel Benítez Sánchez*, Sergio Barrero, Maria R Da Silva, Carlos Martinez, Guillermo Manuel Tirado and Sonia Cruz

Published: 13 May, 2024 | Volume 8 - Issue 2 | Pages: 066-075

Introduction: Post-dilution online hemodiafiltration is the most efficient extracorporeal depurative treatment of CKD. Recently a new type of membrane has been developed, with a higher cut-off point also called a medium cut-off point, which has the capacity to eliminate higher molecular weight molecules in hemodialysis. The hemodialysis performed with these membranes has been called “Expanded Hemodialysis”.
Objective: Compare the purifying efficacy of medium and high molecular weight molecules in patients dialyzed with high-flux hemodialysis, VitaPES 210HF, and with patients treated with expanded hemodialysis with the medium cut-off dialyzer, Elisio-HX.
We also assessed the effect that the increased removal of inflammatory mediators by MCO hemodialysis had on fecal Calprotectin levels.
Patients and methods: This is a prospective observational cross-over study in which 8 prevalent hemodialysis patients were followed for two months. Blood levels of IL-6, C-reactive protein (CRP), β2-microglobulin, Kappa and Lambda immunoglobulin light chains, and serum albumin were determined before and after each hemodialysis session.
Results: The percentage of reduction of medium and higher molecular weight molecules: β2microglobulin, IL-6, Kappa and Lambda chains and CRP were higher with the Elisio-21HX dialyzer compared to the VitaPES 210HF dialyzer. There was no difference in albumin clearance between the two dialyzers.
Fecal calprotectin levels were lower in patients dialyzed with Elisio-21HX.
Conclusion: The medium cutoff dialyzer, Elisio-HX, is more efficient in the elimination of medium/high molecular weight molecules than the VitaPES HF high-flux dialyzer, with the same albumin elimination.
Improving inflammation at the local intestinal level with lower levels of fecal Calprotectin.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001129 Cite this Article Read Full Article PDF

Keywords:

Extended hemodialysis; Depurative efficacy; Reduction ratio; β2 Microglobulin; IL-6; Inflammation; Calprotectin

References

  1. Maduell F, Broseta JJ, Rodríguez-Espinosa D, Del Risco J, Rodas LM, Arias-Guillén M, Vera M, Fontseré N, Salgado MDC, Rico N. Comparison of four medium cut-off dialyzers. Clin Kidney J. 2022 Jul 13;15(12):2292-2299. doi: 10.1093/ckj/sfac167. PMID: 36381368; PMCID: PMC9664569.
  2. Boschetti-de-Fierro A, Voigt M, Storr M, Krause B. Extended characterization of a new class of membranes for blood purification: the high cut-off membranes. Int J Artif Organs. 2013 Jul;36(7):455-63. doi: 10.5301/ijao.5000220. Epub 2013 May 10. PMID: 23661558.
  3. Castillo-Rodriguez E, Fernandez-Prado R, Esteras R, Perez-Gomez MV, Gracia-Iguacel C, Fernandez-Fernandez B, Kanbay M, Tejedor A, Lazaro A, Ruiz-Ortega M, Gonzalez-Parra E, Sanz AB, Ortiz A, Sanchez-Niño MD. Impact of Altered Intestinal Microbiota on Chronic Kidney Disease Progression. Toxins (Basel). 2018 Jul 19;10(7):300. doi: 10.3390/toxins10070300. PMID: 30029499; PMCID: PMC6070989.
  4. Zhernakova A, Kurilshikov A, Bonder MJ, Tigchelaar EF, Schirmer M, Vatanen T, Mujagic Z, Vila AV, Falony G, Vieira-Silva S, Wang J, Imhann F, Brandsma E, Jankipersadsing SA, Joossens M, Cenit MC, Deelen P, Swertz MA; LifeLines cohort study; Weersma RK, Feskens EJ, Netea MG, Gevers D, Jonkers D, Franke L, Aulchenko YS, Huttenhower C, Raes J, Hofker MH, Xavier RJ, Wijmenga C, Fu J. Population-based metagenomics analysis reveals markers for gut microbiome composition and diversity. Science. 2016 Apr 29;352(6285):565-9. doi: 10.1126/science.aad3369. Epub 2016 Apr 28. PMID: 27126040; PMCID: PMC5240844.
  5. Ortiz PDS, Garcia RP, Vega A, Maduell F. Preliminary Data from MOTHER HDX Study: A Multicentre Open-label RCT Study to Explore the Morbimortality with the Theranova HDX vs OL-HDF. Nephrol Dial Transplant. 2023 Jun 1;38(Supplement_1):gfad063c_3472.
  6. Kirsch AH, Lyko R, Nilsson LG, Beck W, Amdahl M, Lechner P, Schneider A, Wanner C, Rosenkranz AR, Krieter DH. Performance of hemodialysis with novel medium cut-off dialyzers. Nephrol Dial Transplant. 2017 Jan 1;32(1):165-172. doi: 10.1093/ndt/gfw310. Erratum in: Nephrol Dial Transplant. 2021 Jul 23;36(8):1555-1556. PMID: 27587605; PMCID: PMC5837492.
  7. Boschetti-de-Fierro A, Beck W, Hildwein H, Krause B, Storr M, Zweigart C. Membrane Innovation in Dialysis. In: Ronco C, editor. Expanded Hemodialysis: Innovative Clinical Approach in Dialysis [Internet]. S.Karger AG; 2017 [cited Nov 28, 2023]. p. 0. Available from: https://doi.org/10.1159/000479259.
  8. Lim JH, Park Y, Yook JM, Choi SY, Jung HY, Choi JY, Park SH, Kim CD, Kim YL, Cho JH. Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients. Sci Rep. 2020 May 8;10(1):7780. doi: 10.1038/s41598-020-64622-z. PMID: 32385307; PMCID: PMC7210312.
  9. Bunch A, Sanchez R, Nilsson LG, Bernardo AA, Vesga JI, Ardila F, Guerrero IM, Sanabria RM, Rivera AS; Colombian Registry of Expanded Hemodialysis investigators. Medium cut-off dialyzers in a large population of hemodialysis patients in Colombia: COREXH registry. Ther Apher Dial. 2021 Feb;25(1):33-43. doi: 10.1111/1744-9987.13506. Epub 2020 May 29. PMID: 32352233; PMCID: PMC7818220.
  10. Maduell F, Varas J, Ramos R, Martin-Malo A, Pérez-Garcia R, Berdud I, Moreso F, Canaud B, Stuard S, Gauly A, Aljama P, Merello JI. Hemodiafiltration Reduces All-Cause and Cardiovascular Mortality in Incident Hemodialysis Patients: A Propensity-Matched Cohort Study. Am J Nephrol. 2017;46(4):288-297. doi: 10.1159/000481669. Epub 2017 Oct 17. PMID: 29041011.
  11. Zickler D, Schindler R, Willy K, Martus P, Pawlak M, Storr M, et al. Medium Cut-Off (MCO) membranes reduce inflammation in chronic dialysis patients - A randomized controlled clinical trial. PLoS ONE [Internet]. 2017;12(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85009286665&doi=10.1371%2fjournal.pone.0169024&partnerID=40&md5=d17c993a178ed064067d53be07b0a560.
  12. de Sequera P, Corchete E, Bohorquez L, Albalate M, Perez-Garcia R, Alique M, Marques M, García-Menéndez E, Portolés J, Ramirez R. Residual Renal Function in Hemodialysis and Inflammation. Ther Apher Dial. 2017 Dec;21(6):592-598. doi: 10.1111/1744-9987.12576. Epub 2017 Oct 3. PMID: 28971592.
  13. Wolley MJ, Hutchison CA. Large uremic toxins: an unsolved problem in end-stage kidney disease. Nephrol Dial Transplant. 2018 Oct 1;33(suppl_3):iii6-iii11. doi: 10.1093/ndt/gfy179. PMID: 30281131; PMCID: PMC6168891.
  14. Latosinska A, Hulko M, Speidel R, Mischak H, Storr M, Krause B. Removal of Cell-Activating Substances Using Dialyzers With Various Permeability Profiles. Artif Organs. 2018 Jan;42(1):78-87. doi: 10.1111/aor.12952. Epub 2017 Jul 26. PMID: 28744941.

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