Abstract
Disruptive technologies for hemodialysis: medium and high cutoff membranes. Is the future now?
Highlights
A typical adult dialyzer has around 15,000 hollow fibers tightly packet, forming a compact bundle placed inside a 20 cm plastic tube
This was a proof of concept study, demonstrating that the permeability of the medium cutoff (MCO) and high cutoff (HCO) membranes to middle molecules favors a one-way direction since the external layer of these membranes and the tridimensional configuration repeal middle molecules and only allow the entrance of small molecules dragged in by the backfiltration mechanism (Figure 2)
The REMOVAL-HD trial[35] showed a higher reduction ratio (RR) and a sustained reduction in the pre-dialysis concentration of free light chains (FLC) favoring MCOHD over HF-HD. It is highly debatable if the better clinical outcomes achieved with HF-HDF13 can be extrapolated for MCO-HD, based on the fact that the removal of middle molecules is similar for both modalities
Summary
A typical adult dialyzer has around 15,000 hollow fibers tightly packet, forming a compact bundle placed inside a 20 cm plastic tube. The results demonstrated a similar concentration of endotoxins in the blood compartment, irrespective of the membrane This was a proof of concept study, demonstrating that the permeability of the MCO and HCO membranes to middle molecules favors a one-way direction since the external layer of these membranes and the tridimensional configuration repeal middle molecules and only allow the entrance of small molecules dragged in by the backfiltration mechanism (Figure 2). The REMOVAL-HD trial[35] showed a higher RR and a sustained reduction in the pre-dialysis concentration of FLC favoring MCOHD over HF-HD It is highly debatable if the better clinical outcomes achieved with HF-HDF13 can be extrapolated for MCO-HD, based on the fact that the removal of middle molecules is similar for both modalities. The possibility of utilizing the MCO filter for CKRT seems appealing as it merges the advantages of CVVHD (increased filter life span) and CVVH/CVVHDF (higher clearance of inflammatory mediators)[39]
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