Abstract
Expanded hemodialysis (HDx) with medium cutoff (MCO) membranes, which remove middle-to-large molecules well, may be a good option to replace online hemodiafiltration (online-HDF). To provide more evidence, this randomized controlled trial compared several cardiovascular parameters between patients undergoing HDx and online-HDF. Eighty patients undergoing thrice-weekly hemodialysis were randomly assigned to receive either HDx with a Theranova membrane (n = 43) or online-HDF (n = 37). The primary endpoints were changes in brachial-ankle pulse wave velocity (baPWV), echocardiographic parameters, and coronary artery calcium (CAC) scores over 1 year, and the secondary endpoints included blood cardiovascular biomarkers, mortality, and patient-reported outcomes. A linear mixed model and log-rank test were used to estimate the group differences. 65 patients had completed the trial. The changes in baPWV and echocardiographic parameters did not differ between the two groups. The CAC scores remained stable in the online-HDF group, whereas an increasing trend was shown in the HDx group (P = 0.012). Other endpoints, including cardiovascular and all-cause mortalities, were similar between the two groups. The changes in cardiovascular parameters did not differ between HDx with an MCO membrane and online-HDF. However, attention may be needed in patients with high CAC scores or scores with an increasing tendency when online-HDF is replaced with HDx with an MCO membrane.
Highlights
Expanded hemodialysis (HDx) with medium cutoff (MCO) membranes, which remove middle-tolarge molecules well, may be a good option to replace online hemodiafiltration
Among 5 patients who withdrew consents in the HDx group after starting trial, 2 patients refused to receive tests, 2 patients switched to other hemodialysis modes due to patient need, and 1 patient was transferred to another center
Conventional HD may not be enough to remove all uremic toxins, middle-to-large molecules. This prospective, open-label, multicenter, randomized, controlled trial indicated that HDx with an MCO membrane was not inferior to onlineHDF in terms of cardiovascular risk according to the change trends in the values of brachial-ankle pulse wave velocity (baPWV), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), E/e′, and other blood biomarkers
Summary
Expanded hemodialysis (HDx) with medium cutoff (MCO) membranes, which remove middle-tolarge molecules well, may be a good option to replace online hemodiafiltration (online-HDF). Expanded HD (HDx) is a treatment in which diffusion and convection are integrated inside a dialyzer equipped with a medium cutoff (MCO) membrane[27] This novel HD method has shown greater removal of middle-to-large molecules than conventional H D28–31. Because online-HDF was associated with improved cardiovascular survival compared with a high-flux dialyzer in some pooled analyses[19,20], this randomized, controlled study tried to address the noninferiority of HDx with an MCO membrane to online-HDF in terms of cardiovascular outcomes For this purpose, several cardiovascular parameters, such as brachial-ankle pulse wave velocity (baPWV), echocardiography, and blood markers, were traced over a one-year study period
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