Abstract
This prospective multicenter randomized comparative cross-over trial aimed at evaluating the influence of hemodialysis vs post-dilution hemodiafiltration with high-flux dialyzers in solute clearance and biocompatibility profile. 32 patients were sequentially dialyzed with Leoceed-21HX, Polypure-22S+, Rexsys-27H and VIE-21A. Primary outcome was β2-microglobulin removal. Secondary outcomes were (i) extraction of other uremic solutes (ii) parameters of inflammation and nutrition and (iii) comparative quantification of perdialytic albumin losses (using total ‘TDC’ vs partial ‘PDC’ collection of dialysate). Significant increases in removal rates of β2-microglobulin (84.7 ± 0.8 vs 71.6 ± 0.8 mg/L), myoglobin (65.9 ± 1.3 vs 38.6 ± 1.3 µg/L), free immunoglobulin light chains Kappa (74.9 ± 0.8 vs 55.6 ± 0.8 mg/L), β-trace protein (54.8 ± 1.3 vs 26.8 ± 1.4 mg/L) and orosomucoid (11.0 ± 1.1 vs 6.0 ± 1.1 g/L) but not myostatin (14.8 ± 1.5 vs 13.0 ± 1.5 ng/mL) were observed in HDF compared to HD when pooling all dialyzers. Rexsys and VIE-A use in both HD and HDF subgroups was associated to a better removal of middle/large-size molecules compared to Leoceed and Polypure, except β2-microglobulin for Rexsys. Inflammatory parameters were unchanged between dialyzers without any interaction with dialysis modality. Mean dialysate albumin loss was comparable between TDC and PDC (1.855 vs 1.826 g/session for TDC and PDC respectively). In addition, a significant difference in albumin loss was observed between dialyzers with the highest value (4.5 g/session) observed using Rexsys. Use of all dialyzers was associated with good removals of the large spectrum of uremic toxins tested and good biocompatibility profiles, with an additional gain in removal performances with HDF. Larger surface area, thinner wall and resultant very high ultrafiltration coefficient of Rexsys should be taken into account in its clear performance advantages.
Highlights
This prospective multicenter randomized comparative cross-over trial aimed at evaluating the influence of hemodialysis vs post-dilution hemodiafiltration with high-flux dialyzers in solute clearance and biocompatibility profile. 32 patients were sequentially dialyzed with Leoceed-21HX, Polypure-22S+, Rexsys-27H and VIE-21A
Significantly higher reduction rate (RR) (p < 0.001), Kt/V (p < 0.001) and K simplified kinetic model (p < 0.001) of serum b2m were observed in HDF compared to HD mode when pooling all dialyzers
CKD-5D patient survival in the long term may be improved by increasing efficacy and quality of renal replacement therapy
Summary
Significantly higher RR, RR-eq and Kt/V of myoG (p < 0.001), FLCκ (p < 0.001), BTP (p < 0.001) and orosomucoid (p = 0.002) were observed in HDF compared to HD mode whatever the dialyzer was. These differences observed between modes still persist within each dialyzer tested except for orosomucoid. Bonferroni post-hoc tests reported that Rexsys use was associated to a better removal of middle/large-size molecules except myoS and orosomucoid compared to Leoceed and Polypure. Total albumin mass was slightly removed with Polypure [median 0.6 (range 0.5–0.7) g] and moderately removed with Leoceed [median 1.4 (range 0.5–3.1) g], VIE-A [median 2.1 (range 1.4–3.5) g] and Rexsys [median 2.8 (range 2.1–4.5) g]
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