Retention of beneficial molecules and coagulation factors during haemodialysis and haemodiafiltration

Manuel Voigt,Adriana Boschetti-De-Fierro,Michael Hulko,Bernd Krause,Ulrike Haug,Michael Gebert,Werner Beck,Markus Storr

doi:10.1038/s41598-019-42783-w

Manuel Voigt, Adriana Boschetti-De-Fierro + Show 6 more

Open Access

https://doi.org/10.1038/s41598-019-42783-w

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Journal: Scientific Reports	Publication Date: Apr 23, 2019
Citations: 15	License type: open-access

Affiliation: Baxter (Germany)

Abstract

Middle molecules (MMs) are associated with the pathology of uraemia, and are not effectively removed by standard extracorporeal treatments. Increased convection used in haemodiafiltration (HDF) can enhance the removal of MMs; however, high-volume HDF is not available to all patients. The new medium cut-off (MCO) membrane has been developed to allow increased removal of MMs using standard haemodialysis (HD). Improved removal of MMs has been shown with the MCO membrane compared with standard high-flux dialysers, but it is not known whether the increased pore size affects the retention of commonly used medications or that of coagulation factors in dialysis patients. Using an in vitro model, the retention of erythropoietin, heparin, insulin, vancomycin and several coagulation factors (Factors II, VII and X, protein C and antithrombin III) was investigated with the MCO membrane dialyser, compared with high-flux dialysers with polysulfone (in HDF) or polyethersulfone membranes (in HD and HDF). The retention of all molecules investigated was comparable between the MCO membrane and the high-flux dialysers. Results from the in vitro studies suggest that switching from a high-flux dialyser to the MCO membrane should not require changes to the medication dosing or anti-coagulation protocols of dialysis patients.

Highlights

The change of erythropoietin concentration observed for the medium cut-off (MCO) membrane in HD mode was similar to that of the PSu membrane in simulated HDF mode
It is important to establish that the expanded removal offered by the new MCO membrane does not negatively impact the various medications required
The activity of coagulation factors and inhibitors may be affected by filtration during HD, the activity of selected coagulation factors and inhibitors was investigated to examine whether there was increased loss with MCO HD compared with standard high-flux HD

Summary

Introduction

Middle molecules (MMs) are associated with the pathology of uraemia, and are not effectively removed by standard extracorporeal treatments. Increased convection used in haemodiafiltration (HDF) can enhance the removal of MMs; high-volume HDF is not available to all patients. Improved removal of MMs has been shown with the MCO membrane compared with standard high-flux dialysers, but it is not known whether the increased pore size affects the retention of commonly used medications or that of coagulation factors in dialysis patients. Middle molecules (MMs) are associated with the pathology of uraemia and play a significant role in uraemic toxicity[2,3,4] They consist of molecules ranging from 500 Da up to ~60 kDa; larger MMs (>15 kDa) and are not effectively removed by standard extracorporeal treatments[3,4]. In clinical studies, improved removal performance of MCO membranes was demonstrated allowing clearance of a wide range of MMs more effectively than high-flux HD, and performance of these membranes exceeded that of high-volume HDF for larger MMs (up to 60 kDa)[9]

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