Abstract
Kidney failure is associated with high morbidity and mortality. Hemodialysis, the most prevalent modality of renal replacement therapy, uses the principle of semipermeable membranes to remove solutes and water in the plasma of patients with kidney failure. With the evolution of hemodialysis technology over the last half century, the clearance of small water-soluble molecules in such patients is adequate. However, middle molecules uremic toxins are still retained in the plasma and cause cardiovascular events, anemia, and malnutrition, which significantly contribute to poor quality of life and high mortality in maintenance hemodialysis patients. A new class of membrane, defined as a medium cut-off (MCO) membrane, has emerged in recent years. Expanded hemodialysis with MCO membranes is now recognized as the artificial kidney model closest to natural kidney physiology. This review summarizes the unique morphological characteristics and internal filtration–backfiltration mechanism of MCO membranes, and describes their effects on removing uremic toxins, alleviating inflammation and cardiovascular risk, and improving quality of life in maintenance hemodialysis patients.
Highlights
Kidney failure, known as end-stage renal disease (ESRD), was recently defined by the Kidney Disease: Improving Global Outcomes Consensus Conference in terms of an estimated glomerular filtration rate below 15 mL/min/1.73 m2 or treatment with dialysis [1]
It has been well established that the accumulation of such toxins in the plasma is associated with cardiovascular risk [8], chronic kidney disease-mineral and bone disorders [9], neurologic manifestations [10], and inflammation [11], which significantly contribute to the poor quality of life and high mortality in maintenance hemodialysis patients
The results showed that three of five KDQOL-SF36 domains, symptoms, effects of kidney disease, and burden of kidney disease, improved compared with baseline and the proportion of patients diagnosed with restless leg syndrome (RLS) significantly decreased from 22.1 to 10% during 12 months of follow-up, suggesting that the expanded clearance of large-middle molecules provided by medium cut-off (MCO) membranes might be associated with improvements in patient Quality of Life (QoL) [100]
Summary
Known as end-stage renal disease (ESRD), was recently defined by the Kidney Disease: Improving Global Outcomes Consensus Conference in terms of an estimated glomerular filtration rate below 15 mL/min/1.73 m2 or treatment with dialysis [1]. Some studies found that the use of HCO membranes was associated with a large amount of albumin loss and even clinical hypoalbuminemia, which limited their routine application in chronic hemodialysis [28] In this context, recent advances in the membrane manufacturing industry have led to the development of a novel class of dialysis membrane with MWCO close to MW of albumin and very high retention onset, previously called medium cut-off (MCO) and defined as high retention onset (HRO) membrane, which could better reduce the circulating levels of middle molecules, while allowing albumin to remain in the plasma [13,29,30]. We set out to systemically discuss the morphological characteristics and internal filtration–backfiltration mechanism of MCO membranes and describe their effects on removing uremic toxins, alleviating inflammation as well as cardiovascular risk, and improving quality of life in maintenance hemodialysis patients. This tight pore distribution enhances the permeability and selectivity of MCO membranes
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