Low-flux Membranes Research Articles

A novel study on the quality of life index in canine chronic kidney disease treated with incremental intermittent hemodialysis.

In veterinary medicine, health-related quality-of-life index (QOLi) measurements are becoming increasingly important because they are a multifaceted concept that represents not only patients' physical well-being but also clients' emotional health. This study assessed QOLi in dogs receiving incremental intermittent hemodialysis (i-IHD) with high- and low-flux dialyzers. Thirty dogs diagnosed with chronic kidney disease (CKD) Stage IV were randomly divided into two groups of 15 dogs each. A high-flux dialyzer was used in Group I, whereas a low-flux dialyzer was used in Group II. i-IHD was performed on days 0, 2, 4, 19, and 34, whereas QOLi evaluation was performed on days 0, 15, 30, and 45. Both groups exhibited considerable decreases in post-dialysis creatinine, blood urea nitrogen, and phosphorus levels, while Group I experienced notable reductions in post-dialysis triglyceride and cholesterol levels. Dialysis adequacy did not show any significant difference between the clearance rates of high- and low-flux dialyzers. The QOLi assessment showed better post-dialysis scores in all categories except for water balance in Group I, while Group II demonstrated a worsening trend in scores for mental status, appetite, mobility, general health, and pain. In the first three sessions of i-IHD, dogs with CKD should be treated every other day, and the schedule can be extended by 15 days after that. A high-flux membrane, which effectively decreases triglyceride and cholesterol levels more than a low-flux membrane, warrants consideration for dogs with cardiovascular complications undergoing dialysis. The dialysis-related QOLi aids in clinical decision-making and encourages client engagement.

Comparison of the Efficacy of High Flux versus Low Flux membranes in Chronic Hemodialysis children

Comparison of the Efficacy of High Flux versus Low Flux membranes in Chronic Hemodialysis children

High Flux versus Hemodiafiltration in Removal of Indoxyl Sulphate

Abstract Background protein-bound compounds such as the p-cresol conjugates p-cresyl sulphate (p-CS) and Indoxyl sulphate (IS) have attracted most interest in recent years due to their poor clearance by conventional dialysis and their potential toxicity. Aim of the Study To compare removal of indoxyl sulphate toxin during single session between low flux, high flux hemodialysis and hemodiafiltration. Methods Cross sectional study was concluded upon 60 randomly selected ESRD patients on regular hemodialysis from nephrology Department in Ain Shams University Hospitals. Serum indoxyl sulphate was measured (pre dialysis and post dialysis) using low flux, high flux hemodialysis and hemodiafiltration. Results 60 test subjects were randomly selected had mean age 43.95 (±11.91 years) in low flux HD group, 48.35 (±13.25 years) in high flux HD group and 45.10 (±18.56 years) in HDF group, were males 66.67 % (n = 40) and females 33.33% (n = 20). The mean indoxyl sulphate reduction ratio using low flux filter was 13.5% (±9.52), using high flux 19.7% (±14.31) and in hemodiafiltration 24.2% (±10.73). There was a statistically significant difference between low flux HD group and HDF group as regard indoxyl sulphate reduction ratio (P value 0.015). There was no statistically significant difference between high flux HD group and HDF group as regard indoxyl sulphate reduction ratio. Conclusion Removal of indoxyl sulphate by hemodiafiltration is higher than hemodialysis using low flux membrane and there is no difference between hemodiafiltration and high flux hemodialysis.

Medium Cut-Off versus Low-Flux Dialyzers in Hemodialysis Patients with COVID-19: Clinical Outcomes and Reduction in Interleukin-6

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused extensive morbidity and mortality worldwide. Hemodialysis (HD) patients are both vulnerable to COVID-19 infection and tend to suffer greater disease severity and mortality. This retrospective study aimed to compare medium cut-off (MCO) and low-flux (LF) membrane dialyzers in terms of interleukin-6 (IL-6) reduction, change in inflammatory state, intradialytic complications, and mortality in chronic HD patients with COVID-19. Method: HD patients with a confirmed COVID-19 infection were admitted to the hospital for 10–14 days and underwent HD at the COVID-HD unit. Choice of dialyzer membrane used (MCO vs. LF) depended on the primary nephrologist(s). We collected data on demographics, baseline characteristics, laboratory results, diagnosis, treatments, HD prescription, hemodynamic status during HD, and mortality at 14 and 28 days after. Results: IL-6 reduction ratio (RR) in the MCO group was 9.7 (interquartile range, 71.1) percent, which was significantly higher than that of the LF group (RR, −45.7 [interquartile range, 70.2] percent). The incidence rate of intradialytic hypotension in the MCO group was 3.846 events per 100 dialysis hours (95% confidence interval [CI], 1.954–6.856), which was significantly lower than that of the LF group (9.057; 95% CI, 5.592–13.170). Overall, mortality was not significantly different between the two groups. Conclusion: The MCO membrane was more effective in removing IL-6 and was better tolerated than the LF membrane. Large, randomized controlled trials are required to confirm the relative benefits of the MCO membrane, especially mortality. However, due to the COVID-19 pandemic, our results suggest that the MCO membrane may be beneficial in chronic HD patients with COVID-19.

Effect of Different Dialysis Membranes on Protein Loss During Hemodialysis

Objective: To compare the loss of proteins with high and low flux hemodialysis membranes.
 Study Design: Cross-sectional analytical study.
 Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2019 to Feb 2020.
 Methodology: This study was conducted on patients with end-stage renal disease on maintenance haemodialysis. We excluded patients on haemodialysis for less than one month, those with poor compliance to hemodialysis, those undergoing hemodialysis for less than four hours per session and unwilling patients. Patients were divided into two groups: one was dialyzed with high flux membranes, whereas low flux membranes were used for the other group. Dialysate samples were collected during the first hour and then during the last hour of each haemodialysis session to estimate protein losses in each group.
 Results: Data were recorded during 133 hemodialysis sessions, the patients underwent. There were 22 patients, including 12 (54.55%) males, having a mean age of 46.45±13.99 years. Most patients (17, 77.27%) were on twice-a-week dialysis, whereas the rest were dialyzed thrice weekly. Protein loss was 0.45± 0.23g/L with low flux membranes and 1.20±0.60g/L with high flux membranes. This difference was statistically significant (p= <0.001).
 Conclusion: High flux dialysis membranes are associated with greater protein loss during hemodialysis.

Effects of Low-Flux and High-Flux Dialysis Membranes on Erythropoietin Responsiveness in Hemodialysis Patients.

Background Chronic kidney disease (CKD) is often accompanied by anemia. High-flux membranes contribute to a reasonable removal of uremic toxins which cause anemia in CKD. Inadequate data have described the efficiency of high-flux dialysis in promoting erythropoietin responsiveness in CKD patients in the Middle East. This study was conducted to compare the efficiency of maintaining high-flux hemodialysis versus low-flux dialysis for ≥1 year in promoting erythropoietin responsiveness and to show the factors associated with erythropoietin hyporesponsiveness in Arab chronic hemodialysis patients. Methods It was a retrospective cohort study that involved 110 subjects who were categorized into group 1 (50 patients receiving low-flux dialysis) and group 2 (60 patients receiving high-flux dialysis). History taking, examination, and laboratory investigations were conducted for all patients every 3 months from January 2021 to January 2022. Results Group 2 had significantly higher weight and body mass index than group 1 but lower cholesterol and intact parathyroid hormone levels than group 1. Erythropoietin resistance index levels did not differ between the two groups upon repeated measures over a 1-year follow-up. Significant risk factors for erythropoietin hyporesponsiveness on multivariate analysis were lower weight (Odds ratio (OR): 0.966; 95% Confidence interval (CI): 0.94–0.992; p=0.011), longer hemodialysis vintage (OR: 1.172; 95% CI: 1.036–1.325; p=0.012), lower hemoglobin levels (OR: 0.531; 95% CI: 0.362–0.779; p=0.001), and higher neutrophil-to-lymphocyte ratio (OR: 2.436; 95% CI: 1.321–4.493; p=0.004). Conclusion High-flux dialysis was not superior to low-flux dialysis in improving erythropoietin responsiveness.

MO805: Combination of Conventional Haemodialysis with Haemoperfusion: Does it Provide any Benefits to Haemodialysis Patients?

Abstract BACKGROUND AND AIMS Conventional haemodialysis (HD) with low-flux membranes does not provide adequate middle molecular weight (MMW) clearance of uremic toxins [1]. The potential for better removal of parathyroid hormone (PTH) and β2-microglobulin (β2M) was investigated using a combination of low-flux HD and haemoperfusion (HP) (HD + HP). METHOD A total of 16 stable HD male patients, free of infections, malignancies or haematological disorders, under usual medications for anaemia and hyperparathyroidism, treated with low-flux polysulfone membranes, were randomized into two groups: group A (GA) included eight patients under HD + HP and group B (GΒ) included eight patients under HD only. In GA patients, a type HA130 HP cartridge was connected in parallel to the dialyzer, once a week for the first month, once every 2 weeks for the second month and once a month for the next 4 months. A third group C (GC) was also studied, consisting of eight males undergoing online haemodiafiltration (OL-HDF). In all three groups, serum β2M and iPTH levels were determined at months 0 and 6, before (preD) and after (postD) the mid-week session. RESULTS Serum preD-β2M levels were similar in groups A and B at month 0 (44.1 ± 8.6 versus 34.6 ± 16.2 mg/L; P = NS) and at month 6 (46.1 ± 7.6 versus 41.1 ± 18.9 mg/L; P = NS). In GC, preD–β2M values were lower compared with GA at month 0 (31.1 ± 4.2 mg/L; P = .008) and at month 6 (33.8 ± 6.82 mg/L; P = .02), and postD–β2M values decreased significantly at month 0 (7.4 ± 1.9 mg/L; P < .001) and at month 6 (9.9 ± 3.8 mg/L; P < 0.001). The reduction was maintained, with no difference between month 0 and month 6. An improvement/decrease in β2M values was observed between month 0 and month 6 only in GA (–5.8 ± 7. 2 versus 1.8 ± 5 mg/L; P = .03) but not in GB. PreD–iPTH values did not differ between groups A, B and C at month 0 (623 ± 432 versus 434 ± 350 versus 710 ± 286 pg/mL, respectively; P = NS) and at month 6 (758 ± 550 versus 383 ± 186 versus 559 ± 296 pg/mL, respectively; P = NS). PostD–iPTH values showed a decrease at month 6 in GA (from 758 ± 550 to 514 ± 474 pg/mL; P = .04) but not in GB and a mild decrease in GC (from 559 ± 296 to 363 ± 295 pg/mL; P = .05), with a marginal reduction improvement between month 0 and month 6 in GC (41 ± 55 versus 196 ± 87 pg/mL; P = .046). CONCLUSION OL-HDF is obviously the most effective method for the elimination of MMW uremic toxins [2]. Interestingly, the combination HD + HP seems to be more effective than low-flux HD alone [3], and it could be useful for specific patient cases in daily clinical practice.

MO643: Haemoperfusion Combined with Standard Haemodialysis May Have a Beneficial Effect on Serum Beta-2 Microglobulin Levels in Chronic Haemodialysis Patients

Abstract BACKGROUND AND AIMS Standard haemodialysis (HD) with low-flux membranes does not provide adequate middle molecular weight (MMW) clearance of uraemic toxins [1] and on-line haemodiafiltration (OL-HDF) may not be easily applicable and cost effective in some centres. We investigated whether low-flux conventional HD combined with hemoperfusion (HP) may offer any benefit regarding serum beta-2 microglobulin (β2M) levels as a surrogate of middle molecules in patients haemodialyzed for many years and we compared the method-combination with OL-HDF. METHOD We studied 24 stable anuric patients during 6 months, under standard medical therapy, aged 69 years (46–90), M: F = 20:4, on chronic HD for 84 (65–286) months, who formed three groups: A (GrA), B (GrB) and C (GrC). Each group included 8 age- and HD vintage-matched patients respectively. In GrA patients, a type HA130 cartridge for HP was connected in parallel to the low-flux polysulfone dialyzer and this combination of standard HD with HP (HD + HP) was used once a week for the first month, once every 2 weeks for the second month and once a month for the next 4 months. GrB patients underwent only standard HD treatment with low-flux polysulfone membranes and GrC patients were treated with OL-HDF. In all three groups serum β2M levels were determined at months 0 (M0) and 6 (M6), before (pre-dialysis, preD) and after (post-dialysis, postD) the second weekly session. RESULTS Serum preD β2M levels ​​were similar in GrA and GrB at M0 (44.1 ± 8.6 versus 34.6 ± 16.2 mg/L; P = NS) and at M6 (46.1 ± 7.6 versus 41.1 ± 18.9 mg/L; P = NS). In GrC, preD-β2M values were lower compared with GrA at both M0 (31.1 ± 4.2 mg/L; P = .008) and M6 (33.8 ± 6.82 mg/L; P = .02). In GrC, serum postD-β2M levels ​​decreased significantly at both M0 (7.4 ± 1.9 mg/L; P < .001) and M6 (9.9 ± 3.8 mg/L; P<.001). The postD reduction was maintained, with no difference between M0 and M6. An improvement/decrease in β2M values ​was observed only in GrA between M0 and M6 (−5.8 ± 7.2 versus 1.8 ± 5mg/L; P = .03) but not in GBr. CONCLUSION OL-HDF is obviously the most effective method for elimination of MMW uraemic toxins and in particular β2M [2–3]. Interestingly, the combination HD + HP seems to be more effective than low-flux HD alone [4] and it could be useful for specific patient cases in daily clinical practice in order to prevent or delay the onset and deterioration of symptomatic amyloidosis. Possible result improvement with a more frequent use of HD + HP needs further investigation.

MO915: Factors Related to Chronic Kidney Disease–Associated Pruritus in Patients Undergoing Haemodialysis and its Effects on Quality of Life

Abstract BACKGROUND AND AIMS Chronic kidney disease-associated pruritus (CKD-aP) is an often overlooked, common and debilitating problem for patients undergoing haemodialysis. Although the prevalance of CKD-aP has decreased over the years, it continues to be a problem associated with quality of life impairment, sleep disturbances, increased mortality and morbidity. With this study, we aim to investigate factors related to CKD-aP and its impact on patients’ quality of life. METHOD We conducted a cross-sectional study of in-centre HD patients in the city of Eskişehir, Turkey. A total of 298 patients undergoing HD for >3 months were enrolled in the study. We analysed demographic characteristics, routine laboratory values, interdialytic weight gain, residual urine output, xerosis, 5D itch scale scores (multidimensional itch-related questionnaire), VAS score (ranging from no itching to the worst itching imaginable) and LANSS score (neuropathic pain assessment scale) of enrolled patients. RESULTS Mean age of 298 patients was 64.6 ± 13.2 and 52% of patients were male. Pruritus prevalence in the study group was 45%. The 5D scores were higher among patients with < 200 mL residual urine output versus patients with >500 mL residual urine output (P = .034). The 5D scores were higher among patients with xerosis (P < .001). The 5D scores were again higher among patients with a LANSS score of ≥ 12 (P < .001). The 5D scores were lower among the low-flux membrane group versus the high-flux membrane group (P = .001). The 5D scores were correlated with interdialytic weight gain (r = 0.124; P = .033), Kt/V (r = –0.228; P < .001), ALT levels (r = 0.135; P = .02), total iron binding capacity (r = .13; P = .025) and VAS scores (r = 0.969; P < .001). There were no statistically significant correlations between 5D scores and age, body mass index, HD duration, creatinine, BUN, calcium, phosphorus, calcium-phosphorus product (CAxP) and other routinely tested laboratory values. CONCLUSION In our study, we identified residual urine output, xerosis, neuropathic pain, HD membrane type, interdialytic weight gain, Kt/V, ALT and TIBC as factors related to CKD-aP. The strong relationship between itch severity and neropathic pain scores was especially notable. More research in this field may be beneficial for identifying new therapeutic targets for CKD-aP.

Vancomycin pharmacokinetics in patients treated with intermittent haemodialysis based on therapeutic drug monitoring

Vancomycin is frequently used in haemodialysis (HD) patients but generally accepted target serum ranges and dosing strategy are still lacking in this group. Based on retrospective analysis of data from 118 HD patients treated with vancomycin the interdialytic elimination constant (Ke), apparent volume of distribution (Vd) and dialysis efficacy were calculated. The influence of possible clinical variables on the pharmacokinetic parameters of vancomycin have been tested. The median of Ke in interdialytic periods, corresponding half-life and Vd were 0.0073 h−1, 95.0 h and 0.87 L/kg, respectively. We found significant positive correlation between time in dialysis program and Ke. The Vd correlated best with lean body mass (LBM). For high- and low flux membrane HD of 4 hours duration the decline in vancomycin levels was 20.88% and 12.86%, respectively. Based on these data loading dose for vancomycin in HD patient should be calculated as 24.483 × LBM (kg) + 455 mg. The utility of this equation for entire HD population should be also verified prospectively.

Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study.

Background: Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality.Methods: This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis.Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03–1.22), P = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92–0.98), P = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02–1.19), P = 0.015] and II [1.10 (1.02–1.39), P = 0.014] but significantly lower for type V [0.91 (0.88–0.94), P < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications.Conclusions: Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.

Comparative Study of Serum Cystatin C and Serum Creatinine Level in Before and After Hemodialysis

Background: Chronic kidney disease (CKD) is a pathophysiologic process characterised by a decrease in nephron number and function, which often leads to end-stage renal disease (ESRD). Serum plasma cystatin C is a new test for determining kidney function. Its accuracy in determining the efficacy of haemodialysis in patients with end-stage renal disease has yet to be determined.&#x0D; Serum cystatin C, which is formed at a constant rate by all nucleated cells and filtered freely by the glomerulus, is neither secreted nor reabsorbed, and is unaffected by non-renal influences.&#x0D; Materials and Methods: This study was a comparative study, conducted in the nephrology Department at DMMC &amp; SMHRC, Nagpur in collaboration with ABVRH and JNMC Wardha, Sawangi (Meghe) during September 2020 to March 2021. Total 25 patient (End stage renal disease) included for the present study, the age group 30-60 years with 17 male patients and 08 female patients.&#x0D; Result: Serum creatinine concentration in the before hemodialysis with 8.72±3.00 and for the after hemodialysis 3.20±1.18(P &lt; 0.0001). The serum cystatin C concentration in the before hemodialysis 5.50±2.09 and for the after hemodialysis 8.7±1.75(P &lt; 0.0001). the process of hemodialysis leads to a significantly low in a serum creatinine concentration as compared to before hemodialysis. The serum cystatin C concentration significantly increase in the after hemodialysis patient as compared to before hemodialysis.&#x0D; Conclusion: Hemodialysis adequacy cannot be determined using serum cystatin C. It does, however, serve as a surrogate marker of dialysis inadequacy, particularly when low flux membranes are used. Routine examination of serum cystatin C in hemodialysis patients will help in the monitoring of the patient's overall clinical condition.

Medium Cut-Off Dialysis Membranes: Can They Have Impact on Outcome of COVID-19 Hemodialysis Patients?

Introduction: Severe acute respiratory syndrome coronavirus-2 may lead to high levels of expression of inflammatory cytokines. Medium cut-off (MCO) membranes may make greater clearances for large-middle molecules (including cytokines) than low-flux (LF) membranes. In this study, we aimed to evaluate the impact of MCO membranes on outcome of COVID-19 patients on hemodialysis (HD). Methods: Sixty COVID-19 HD patients were included in this study. The patients were categorized into 2 groups regarding type of HD membranes. Clinical data were taken from medical records. Results: Initial crp and ferritin levels, which are surragates of cytokine storm and severity of disease in COVID-19, were significantly higher in MCO membrane group compared to LF group (p = 0.037 and 0.000, respectively). Although there were more patients with severe disease in MCO group, there were no significant differences regarding need for intensive care unit and death. Conclusion: It may be an option to use MCO membranes in HD patients with COVID-19 in order to reduce cytokine levels and prevent cytokine storm.

Indications for Dialysis in Acute Kidney Injury

Renal replacement therapy (RRT) can be used to support patient’s kidney function in cases of acute kidney injury (AKI). However, timing, modality, and dosing of RRT continue to remain in question. Recent studies have begun to provide data to help guide clinicians on when to initiate RRT, what form of RRT to use ranging from continuous venovenous hemofiltration (VVH) to intermittent hemodialysis, and the impact of high versus low-intensity dosing. Additionally, the risks associated with temporary vascular access with regard to thrombosis and infection, the impact of high efficiency and flux versus low efficiency and flux membranes, and options for anticoagulation in RRT for AKI are also discussed. This review contains 75 references. Key words: acute kidney injury, chronic kidney disease, continuous venovenous hemofiltration, continuous venovenous hemodialysis, renal replacement therapy, venovenous hemofiltration,

The effect of increasing blood flow rate and dialysate flow rate on dialysis adequacy in maintenance hemodialysis patients

Objective A few publications show that increasing dialysate flow rate(Qd) no longer lead to an increase in Kt/V measurement with using high-flux membrane dialyzers. The aim of this study is to assess the effect of increasing dialysis flow rate or blood flow rate(Qb) during hemodialysis with low-flux membrane dialyzer on the adequacy of dialysis. Methods In this study, 54 patients with maintenance HD were assessed. All patients were dialysed with conventional bicarbonate heamodialysis and three sessions per week with each Qb(250 mL/min or 500 mL/min) and Qd (500 mL/min or 800 mL/min) were performed. Delivered dose of dialysis, measured by Kt/Vsp, was assessed during last dialysis session per week. Kt/Vsp was calculated according to the equations by Daugirdas. Blood samples were drawn immediately predialysis and postdialysis from the arterial of the access. HD parameters were acquired directly from the monitor display: effective blood flow rate, Qd, ultrafiltration volume and dialysis time. Results A total number of 46 patients including 30 males and 16 females were studied. The mean age of the studied population was (52.78±11.12) years and the mean dialysis duration was 1057 days. There was no statistical difference in ultrafiltration volumes per week. The relative gains in Kt/Vsp for increasing Qb from 250 to 300 mL/min and Qd from 500 to 800 mL/min was 8% and 4%, respectively. When Qd was 800 mL/min, we spent 2.2 L of acid concentrate and 72.76 L of water more than when Qd was 500 mL/min in only one patient per HD session. Conclusions Increasing Qb from 250 to 300 mL/min is associated with a more efficient increase in Kt/Vsp than increasing Qd and also less water consumption. Key words: Renal Dialysis; Renal Blood Flow, Effective; Dialysis Solutions

All cellulose electrospun water purification membranes nanotextured using cellulose nanocrystals

Cellulose acetate (CA) fibers were electrospun on a mesh template to create specific surface and pore structures for membrane applications. The mesh template CA fiber mats were impregnated with cellulose nanocrystals at varying weight percentages. The membranes showed nanotextured surfaces and improved mechanical properties post impregnation. More importantly, the hydrophilicity of the original CA fibers was increased from a hydrophobic contact angle of 102°–0° thereby creating an anti-fouling membrane surface structure. The membranes showed rejection of 20–56% for particles of 0.5–2.0 μm, indicating potential of these membranes in rejecting microorganisms from water. Furthermore, high rejection of dyes (80–99%) by adsorption and potential application as highly functional affinity membranes was demonstrated. These membranes can therefore be utilized as all-cellulose, green, scalable and low cost high flux membranes (> 20,000 LMH) for water cleaning applications in food industry where microorganisms and charged contaminants are to be removed.

Procalcitonin as an inflammatory marker in comparison between high-flux and low-flux hemodialysis in patients with end-stage renal disease

Background Although procalcitonin (PCT) has been described as a new marker of infection and inflammation, it has not been extensively studied in hemodialysis (HD) patients. Patients and methods We measured PCT serum levels and high-sensitivity C-reactive protein (hs-CRP) before and immediately after HD in 50 adult HD patients (25 treated with high-flux membranes and 25 with low-flux membranes), without history of concurrent infections. Results The baseline PCT levels before HD were higher than healthy individuals. There was a highly significant decrease in PCT serum levels after HD session in patients undergoing HD by high-flux membranes but not by low-flux membranes (high flux 0.54 ng/ml pre-HD vs. 0.26 ng/ml post-HD, P=0.001, whereas in low flux 0.50 ng/ml vs. 0.53 ng/ml, P=0.066). Hs-CRP levels were unchanged in both groups. There was no correlation between PCT and CRP. Conclusion Although PCT is considered a sensitive and specific diagnostic and prognostic marker of systemic bacterial infection, we suggest that specific reference ranges might be developed in patients with impaired renal function; moreover, its clinical usefulness might be limited in patients undergoing HD with high-flux membranes.

Evaluating the effect of N-acetylcysteine on residual renal function in chronic hemodialysis patients treated with low-flux dialysis membrane; a randomized clinical trial

Introduction: The goal of any physician who cares about dialysis patients is to increase their quality of life. Many studies have shown that residual renal function (RRF) in dialysis patients, especially those undergoing peritoneal dialysis (PD), is an important prognostic factor for mortality. Objectives: In the present study, we aimed to investigate the effect of N-acetylcysteine (NAC) as an antioxidant on increasing RRF in chronic hemodialysis (HD) patients. Patients and Methods: Ninety-eight chronic HD patients who have urinary output greater than 100 cc in 24 hours participated in this study and were divided into two groups of treatment and control (49 patients each). Subsequently, the oral NAC treatment group received 600 mg tablets twice a day before meals. The control group received placebo tablets again twice a day before meals. The duration of the study was 4 weeks. Results: The RRF significantly improved in the treatment group during the study period, but no significant changes were observed in the control group. Residual glomerular filtration rate (GFR) rose from 1.7±0.73 to 2.7±1.1 mL/min/1.73 m2 (P<0.0001) in the treatment group, while in the control group, there was a slight increase from 2.1±0.94 to 2.2±1.19 mL/min/1.73 m2 (P=0.26). Additionally, the average daily volume of urine in the treatment group increased from 594±436 to 953±540 mL/24 h (P<0.0001) in the treatment group and from 809±573 to 771±552 mL/24 h (P=0.11) in the control group. Finally, the calculation of residual renal Kt/V per week showed an increase from 0.21±0.06 to 0.31±0.08 (P<0.0001) in the treatment group and a decrease from 0.23±0.08 to 0.22±0.08 (P=0.22) in the control group. Conclusion: Our study showed that a 4-week NAC treatment improves RRF in chronic HD patients.

Proteomics and Protein Adsorption on Hemodialysis Membranes

Adsorption of plasma proteins onto the membrane surface during the hemodialysis session represents a key feature of membranes used for chronic dialysis therapy. In this issue of Proteomics-Clinical Applications, Han etal. originally describe how, by using proteomic technologies, the adsorptive properties of two membranes made from the same biomaterial (Polyamix) may have different flux characteristics (low flux and high flux, the former having smaller pore size). A total of 497 differentially expressed proteins were identified in eluates obtained after in vivo hemodialysis: 320 proteins concentrated more in low-flux membrane (predominantly proteins with molecular weight 30-60 kDa) and 177 in high flux (most represented by proteins with molecular weight 10-15 kDa). Use of bioinformatics tools shed light on the involvement of adsorbed proteins in important biological pathways, such as the coagulation cascade and the complement system, again with some differences between the two membranes. The study indicates that flux characteristics of a biomaterial used for hemodialysis membrane strongly influence its adsorptive properties, and that proteomic application may provide information relevant to renal replacement therapy.

MicroRNA 499 gene expression in patients on hemodialysis with cardiovascular complications.

MicroRNA (miRNA) 499 is an evolutionarily conserved muscle-specific miRNA that is encoded by an intron of the myh7 gene and is likely to play a role in myosin gene regulation. It has been shown to be involved in inhibiting apoptosis and myocardial infarction induced by ischemia and anoxia. It is unknown whether levels of miRNAs are affected in patients undergoing hemodialysis. The aim of this study was to assess circulating levels of miRNA 499 in hemodialysis patients and whether the levels are affected by dialyzer membranes (high flux vs. low flux). The studied population consisted of 32 end stage renal disease (ESRD) patients (22 males and 10 females) with age ranged from 38% to 75% years on regular hemodialysis (4 hours, 3 times weekly) for at least 1 year duration with cardiovascular events in the last 6 months and 32 healthy controls (20 males and 12 females) with an age range from 54 to 60 years. Patients were involved into a two-stage sequential study; high-flux hemodialysis stage (stage I), then low-flux hemodialysis stage (stage II). Expressed levels of plasma miRNA 499 have been measured by Real Time-PCR. Lipid profile, serum phosphorus, serum calcium, serum creatinine, and blood urea were measured in all patients. In this study, 2 patients with an open-heart surgery showed highly elevation in the miRNA 499, while the other patients, showing different degrees of ischemia, had different levels of elevated miRNA 499. Statistically significant higher levels of miRNA 499 in plasma were observed in all the studied patients with cardiovascular diseases compared to the levels of miRNA 499 found in healthy controls (P < 0.0001). MicroRNA 499 was found to be a dialyzable marker. A significant decrease in plasma levels of miRNA 499 was obtained after either high-flux or low-flux dialysis compared to plasma levels of miRNA 499 found before dialysis (P < 0.0001). On comparing both types of hemodialysis membranes with respect to miRNA 499 clearance, we found that low-flux membrane showed better clearance for miRNA 499 than high-flux membrane with a statistically significant difference between them (P < 0.001). In conclusion, miRNA 499 levels are elevated in patients with ESRD with cardiovascular complications. High-flux membrane seems to be less efficient in miRNA 499 clearance in cardiac patients on hemodialysis.