Medium Cut-off Dialyzer Research Articles

Effects of a medium cut-off dialyzer on inflammation and cardiac and vascular function in hemodialysis patients with heart failure.

Expanded hemodialysis (HDx) could provide clearance of larger middle-molecule uremic toxins. We compared the effect of hemodialysis with medium cut-off membranes and high-flux (HFHD) membranes regarding changes in inflammation and vascular and left ventricular function. This was a single-center, prospective, parallel-group comparative study. Patients were divided into two groups (HDx: 25 patients and HFHD: 26 patients). All measurements were performed at baseline and 12 weeks. Serum c-reactive protein, interkelukin-18, pentraxin-3, β-2 microglobulin, and brain natriuretic peptide were measured. We used pulse wave velocity and augmentation index to assess arterial stiffness and echocardiography to evaluate left and right ventricular function. We enrolled 51 patients. Although serum c-reactive protein, interkelukin-18, pentraxin 3, and β-2 microglobulin were significantly decreased in the HDx group (p = 0.02, p < 0.001, p = 0.002, and p = 0.02, respectively), there was no significant change in HFHD group at 12th week. Serum c-reactive protein and interkelukin-18were significantly lower in the HDx group compared to the HFHD group in the 12th week (p = 0.007 and p = 0.03, respectively). We observed a significant decrease in pulse wave velocity in the HDx group at the end of the study (p = 0.03). Although there was no significant change in pulse wave velocity in the HFHD group, pulse wave velocity was similar between the HDx and HFHD groups in the 12th week. We detected a significant decrease in the mean isovolumetric relaxation time in the HDx group (p = 0.006). However, there was no significant difference in isovolumetric relaxation time between the HDx and HFHD groups in the 12th week. HDx provides better clearance of middle molecular uremic toxins and inflammatory biomarkers, and it may be associated with better central hemodynamic parameters and diastolic functions.

#360 Short-term treatment with medium cut-off dialyzers increases muscle mass with preserved fat tissue in maintenance HD patients

Abstract Background and Aims Protein-energy wasting is a significant complication of maintenance hemodialysis (HD) patients characterized by reduced fat or muscle mass and strength. The combination of non-modifiable general and disease-related factors, such as uremic toxin accumulation and systemic inflammation, is responsible for this condition. Medium cut-off (MCO) membranes are designed to provide clearance of large-middle molecular weight uremic toxins and inflammatory cytokines without causing loss of albumin. This study aimed to investigate the short-term effect of MCO dialyzers on fat tissues and muscle mass. Method We conducted a prospective, single-center cross-over study on maintenance HD patients treated with regular low-flux (LF) dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strength parameters from six different muscle groups were evaluated with ultrasound. The baseline (control) parameters were measured under LF dialyzers, and the measurements were repeated two weeks after switching to MCO dialyzers for the patients ordered by their clinicians according to the clinical indications. Results The median age was 69.5 (50.3,78.8) years, and 60% of the patients were female. Two weeks after switching to MCO, the Kt/Vs, urea reduction ratios, mean serum albumin, dry weight, and body mass index scores were similar. Mean skinfold thickness and mid-upper arm circumference were 15 mm (11,17) and 28mm (27,30) under LF and 16mm (14,19) and 28mm (27,30) under MCO dialyzers (p=0.82 and p=0.27). Rectus abdominis and external oblique muscle groups remained similar. Internal and external oblique muscle thickness were significantly increased (p=0.002 and p=0.001). Mean rectus femoris and gastrocnemius medialis (GKM) thicknesses were 1.19cm (0.99,1.33) and 1.16cm (0.9,1.4) under LF and 1.31cm (1.20, 1.40) and 1.24cm (0.95,1.40) under MCO dialyzers (p=0.002 and p=0.02). Mean GKM fibrile length and pennation angles were 2.4cm (2.2,2.8) and 20o (18,23) under LF and 2.7cm (2.4, 2.9) and 22o (19,24) under MCO dialyzers (p=0.007 and p=0.001). Conclusion Our study showed that MCO dialyzers increase muscle mass with preserved fat tissues in HD patients, short-term follow-up. This favorable effect might be due to the clearance of uremic toxins, which cannot be removed with conventional methods. If long-term studies support our findings, MCO dialyzers would be a milestone for the treatment of sarcopenia in HD patients.

#2032 Heart rate-adjusted augmentation index reduces after switching low-flux dialyzers to medium cut-off dialyzers in maintenance hemodialysis patients

Abstract Background and Aims Arterial stiffness affects almost all maintenance hemodialysis (MHD) patients and is one of the most important predictors of cardiovascular morbidity and mortality. Medium cut-off (MCO) membrane technology provides higher clearance of large-middle uraemic toxin and cytokines compared to conventional dialyzers. In this case-control study, we investigated the change in the arterial stiffness parameters after the transition to MCO dialyzers in MHD patients receiving treatment with low-flux dialyzers. Method We conducted a prospective, single-center cross-over study including 19 MHD patients receiving treatment with low-flux dialyzers. Baseline and repeated parameters were measured from the brachial artery on a mid-week HD session at 0th, 120th, and 240th minutes, and the average of the three measurements were analyzed. The repeated parameters were measured two weeks after the switching to MCO dialyzers which were decided by the clinician according to clinical indication. Results The median age was 71 (51, 79) years, and 57.9% of the patients were female. The frequency of diabetes was 36.8%, and hypertension was 73.7%. 21.1% patients were smokers. 31.6% of the patients had a history of cardiovascular disease. Two weeks after switching to MCO dialyzers, the Kt/Vs, urea reduction ratios, laboratory parameters, systolic, diastolic, and mean arterial pressures remained similar to baseline. The mean pulse wave velocity was 10.3 m/s (8.4, 11.0) with low-flux dialyzers and 10.2 m/s (7.0, 11.5) with MCO dialyzers (p = 0.38). The mean heart rate adjusted augmentation index [AIx(75)] was 20.0% (15.0, 30.3) with low-flux dialyzers and 13.0% (11.0, 22.0) with MCO dialyzers (p = 0.04). Conclusion Our study showed that the rapid effect of MCO membranes is the reduction in peripheral wave reflections defined by AIx(75). Additional long-term diseases are required to determine whether MCO dialyzers might improve the cardiovascular prognosis of MHD patients.

#443 LEVIL evaluates the impact of HDx on HR-QoL and symptoms, including durability-of-effect and variability

Abstract Background and Aims Current hemodialysis (HD), utilizing conventional high-flux dialyzers, is handicapped by clearance limitations (larger-sized uremic toxins), which contribute to poor health-related quality-of-life (HR-QoL) and symptom-burden. Recent international consensus and guideline-setting efforts have explicitly prioritized identification and management of symptoms and subjective experience, whilst also acknowledging the lack of tools available to fully appreciate and continuously monitor these challenges. This study aimed to utilize dynamic patient-reported-outcome-measurement tool (PROM), London Evaluation of Illness (LEVIL-developed in-house), to iteratively interrogate patient-experience and to confirm previously reported HR-QoL benefits of the use of expanded hemodialysis (HDx) using medium cut-off dialyzer (extending the spectrum of uremic toxins being addressed). Furthermore, this study aimed to extend appreciation of effects on patient subjective experience to include durability-of-effects, variability of symptom-measures and impact of HDx withdrawal. Methods We conducted a multi-centre interventional study in 47 patients established on conventional thrice weekly centre-based HD in Ontario, Canada. Study protocol was 15-months in length with five phases 1) one-month observation (high-flux-HD), 2) three-months HDx 3) two-month wash-out (high-flux-HD), 4) six-months HDx, 5) three-month wash-out (high-flux-HD). HR-QoL and symptom-burden were evaluated using LEVIL throughout study. Results HDx-therapy improved HR-QoL [p 0.0006 (19% from baseline)] and a variety of symptoms including general wellbeing [p 0.005 (23%)], energy [p 0.004 (33%)], sleep-quality [p 0.001 (33%)], pruritus [0.003 (30%)], pain [p 0.01 (19%)], restless leg syndrome [p 0.0006 (15%)], mood [p 0.02 (12%)], appetite [ p 0.03 (9%)], breathlessness [p 0.001 (9%)], and HD-recovery [p 0.004 (26%)]. Response was more pronounced in those with poorer HR-QoL and higher symptom-burden. Improvements were durable over time with continued use with less symptom-variability (range 10-35% improvement). Improvements diminished gradually with return to high-flux-HD. The drivers of poor HR-QoL were largely general-wellbeing, energy, sleep-quality, pruritus, and bodily pain. Conclusion Use of a dynamic PROM effectively allowed appreciation of HR-QoL burden in HD-patients. Use of HDx-therapy results in improved patient subjective outcomes that are durable and associated with significantly lower variation in important symptom-domains than patients experience with receiving conventional high-flux-HD.

#885 Combination of medium cut-off dialyzer membrane and diet modification to reduce serum concentrations of p-cresyl sulfate and indoxyl sulfate

Abstract Background and Aims Online hemodiafiltration (ol-HDF) may be considered currently as the best choice for chronic hemodialysis (HD) treatment, but medium cut-off (MCO) membranes may provide similar efficiency for larger and protein-bound toxin removal. P-cresyl sulfate (PCS) and indoxyl-sulfate (IS) concentration depends mainly on residual renal function and diet. Increased dietary fiber intake and short-chain fatty acid (SCFA) supplementation were associated with decreased production of PCS and IS. The aim of this study was to pragmatically combine MCO use with diet modification in an attempt to reduce serum concentration of PCS and IS and compare this strategy to online HDF use. Method We report preliminary results from a subset of a study sample with 42 chronic prevalent HD patients in a prospective randomized controlled interventional study. Two weeks after standard bicarbonate HD (BHD), patients were randomized to hemodialysis with MCO membrane (EXP group) or ol-HDF with a standard "high-flux" (HF) dialyzer membrane (CON group). After 4 weeks, both groups were supplemented by a change in the diet with increase of the daily intake of dietary fiber to 30g and addition of a SCFA propionate in the dose of 1g daily for 8 weeks. Two main outcomes were serum concentrations of PCS and IS. Measurements were taken at baseline (after 2 week wash-in period), after 4 weeks of the first intervention phase (MCO vs. ol-HDF; T1), after 8 weeks of the second intervention phase (fiber and SCFA supplementation; T2) and finally, after 4 weeks of wash-out period with BHD (T3). Results From 42 participants, 38 completed the study (63.2% men, 66.4±10.9 years, Charlson comorbidity index 5.7±2.3). In the CON group, serum concentrations of PCS (in μg/ml) were 36.8±19.6 (baseline), 36.9±20.8 (T1), 32.4±17.4 (T2) and 38.6±22.1 (T3). Serum concentrations of IS (in μg/ml) were 31.8±13.0 (baseline), 32.9±14.7 (T1), 29.5±9.1 (T2) and 35.5±16.8 (T3). In the EXP group, serum concentrations of PCS were 33.5± 16.6 (baseline), 35.9±17.8 (T1), 34.0±16.1 (T2) and 37.4±21.5 (T3). Serum concentrations for IS were 39.6±12.6 (baseline), 37.3±12.9 (T1), 42.3±13.5 (T2) and 41.0±12.8 (T3). Repeated measures ANOVA revealed no significant time*group interaction for PCS (F(1,33)=0.479, p=0.698, ŋ2=0.014) and IS (F(1,33)=2.392, p=0.073, ŋ2=0.068). There was a significant within-group increase in serum IS concentration between T2 and T3 in CON group (p=0.042). There was a trend towards a decrease in PCS concentration between T1 and T2 and increase between T2 and T3 in CON group. Conclusion The results of the study suggest both hemodialysis methods are equivalent in eliminating PCS and IS. Additional fiber and SCFA propionate supplementation did not decrease serum PCS and IS concentrations significantly, although there was a trend towards lower serums concentration of PCS after diet modification in CON group.

Elimination of Medium/High Molecular Weight Solutes. Comparison of High Flow Hemodialysis with Extended Hemodialysis

Introduction: Post-dilution online hemodiafiltration is the most efficient extracorporeal depurative treatment of CKD. Recently a new type of membrane has been developed, with a higher cut-off point also called a medium cut-off point, which has the capacity to eliminate higher molecular weight molecules in hemodialysis. The hemodialysis performed with these membranes has been called “Expanded Hemodialysis”. Objective: Compare the purifying efficacy of medium and high molecular weight molecules in patients dialyzed with high-flux hemodialysis, VitaPES 210HF, and with patients treated with expanded hemodialysis with the medium cut-off dialyzer, Elisio-HX. We also assessed the effect that the increased removal of inflammatory mediators by MCO hemodialysis had on fecal Calprotectin levels. Patients and methods: This is a prospective observational cross-over study in which 8 prevalent hemodialysis patients were followed for two months. Blood levels of IL-6, C-reactive protein (CRP), β2-microglobulin, Kappa and Lambda immunoglobulin light chains, and serum albumin were determined before and after each hemodialysis session. Results: The percentage of reduction of medium and higher molecular weight molecules: β2microglobulin, IL-6, Kappa and Lambda chains and CRP were higher with the Elisio-21HX dialyzer compared to the VitaPES 210HF dialyzer. There was no difference in albumin clearance between the two dialyzers. Fecal calprotectin levels were lower in patients dialyzed with Elisio-21HX. Conclusion: The medium cutoff dialyzer, Elisio-HX, is more efficient in the elimination of medium/high molecular weight molecules than the VitaPES HF high-flux dialyzer, with the same albumin elimination. Improving inflammation at the local intestinal level with lower levels of fecal Calprotectin.

Medium cut-off dialyzer improves reduction ratios of large middle molecules associated with vascular calcification.

We aimed to investigate the change in the large middle molecule (>15 kDa) removal rate, which is associated with vascular calcification, when using a medium cut-off (MCO) dialyzer compared to a high-flux (HF) dialyzer. Twenty patients with clinically stable maintenance hemodialysis were investigated over a 15-week study period. Dialyzer efficacies were evaluated during the last midweek hemodialysis treatment for each consecutive dialyzer membrane use: 1st HF, MCO, and 2nd HF dialyzer; 5 weeks each period. Changes in α1-microglobulin (33 kDa) during a dialysis session were analyzed to assess the efficacy of the MCO dialyzer as a reference. The levels and reduction ratios of fibroblast growth factor 23 (FGF23, 32 kDa), osteoprotegerin (OPG, 60 kDa), and sclerostin (22 kDa) were analyzed. Large middle molecules were measured using an enzyme-linked immunosorbent assay. Serum hemoglobin, phosphorus, and corrected calcium levels were not significantly different for each dialyzer period. Total protein and albumin values during the MCO dialyzer period did not decrease compared with the HF dialyzer period. The reduction ratio of α1-microglobulin was significantly higher in the MCO dialyzer than in the HF dialyzer (p < 0.001). The reduction ratios of FGF23 (p < 0.001), OPG (p < 0.001), and sclerostin (p < 0.001) were significantly higher in the MCO dialyzer than those in the HF dialyzer. The reduction rate of large middle molecules related to vascular calcification, such as FGF23, OPG, and sclerostin, was significantly higher when using the MCO dialyzer than the HF dialyzer.

The Impact of Medium Cut-Off Dialyzers on Malnutrition-Inflammation Scores in Maintenance Hemodialysis Patients

Introduction: Medium cut-off (MCO) membranes may be able to remove middle-large uremic toxins that are retained in the body, which has been linked to various risk factors including malnutrition-inflammation score (MIS). The effect of MCO dialyzers on MIS has been studied. Methods: This single-center exploratory prospective observational study enrolled maintenance hemodialysis patients who underwent dialysis using either MCO (Theranova 400) or high-flux (FX80) membranes as part of their regular care. Measurements of MIS, body weight, height, body mass index, and various biochemical markers were taken at the beginning and conclusion of the study. Results: This study included 50 patients who were treated with either the Theranova 400 (n = 25) or the FX80 (n = 25) for a period of 6 months. The two groups were similar in terms of demographics, duration of hemodialysis treatment, and baseline biochemical test results. Theranova 400 had no significant impact on the median MIS (6 [6–10] vs. 7 [5-10], p 0.575) and serum albumin levels (4.07 [3.92–4.22] vs. 4.04 [3.85–4.30], p 0.689), while the FX80 resulted in a significant increase in MIS (6 [5–8] vs. 8 [6–10], p 0.033) and a significant decrease in serum albumin levels (4.23 [4.03–4.36] vs. 3.98 [3.77–4.12], p 0.027) at the end of the study. Discussion/Conclusion: After 6 months of treatment, the MCO dialyzer did not demonstrate a statistically significant difference in the MIS when compared to the high-flux dialyzer. However, MIS worsening was significantly less in the MCO group, indicating the potential benefits of MCO membranes in maintaining nutritional status. Further research is required to validate these results.

Expanded Hemodialysis ameliorates uremia-induced impairment of vasculoprotective KLF2 and concomitant proinflammatory priming of endothelial cells through an ERK/AP1/cFOS-dependent mechanism.

Expanded hemodialysis (HDx) therapy with improved molecular cut-off dialyzers exerts beneficial effects on lowering uremia-associated chronic systemic microinflammation, a driver of endothelial dysfunction and cardiovascular disease (CVD) in hemodialysis (HD) patients with end-stage renal disease (ESRD). However, studies on the underlying molecular mechanisms are still at an early stage. Here, we identify the (endothelial) transcription factor Krüppel-like factor 2 (KLF2) and its associated molecular signalling pathways as key targets and regulators of uremia-induced endothelial micro-inflammation in the HD/ESRD setting, which is crucial for vascular homeostasis and controlling detrimental vascular inflammation. First, we found that human microvascular endothelial cells (HMECs) and other typical endothelial and kidney model cell lines (e.g. HUVECs, HREC, and HEK) exposed to uremic serum from patients treated with two different hemodialysis regimens in the Permeability Enhancement to Reduce Chronic Inflammation II (PERCI-II) crossover clinical trial - comparing High-Flux (HF) and Medium Cut-Off (MCO) membranes - exhibited strongly reduced expression of vasculoprotective KLF2 with HF dialyzers, while dialysis with MCO dialyzers led to the maintenance and restoration of physiological KLF2 levels in HMECs. Mechanistic follow-up revealed that the strong downmodulation of KLF2 in HMECs exposed to uremic serum was mediated by a dominant engagement of detrimental ERK instead of beneficial AKT signalling, with subsequent AP1-/c-FOS binding in the KLF2 promoter region, followed by the detrimental triggering of pleiotropic inflammatory mediators, while the introduction of a KLF2 overexpression plasmid could restore physiological KLF2 levels and downmodulate the detrimental vascular inflammation in a mechanistic rescue approach. Uremia downmodulates vasculoprotective KLF2 in endothelium, leading to detrimental vascular inflammation, while MCO dialysis with the novel improved HDx therapy approach can maintain physiological levels of vasculoprotective KLF2.

Comparison of the medium cutoff dialyzer and postdilution hemodiafiltration on the removal of small and middle molecule uremic toxins.

The medium cutoff (MCO) dialyzer increases the removal of several middle molecules more effectively than high-flux hemodialysis (HD). However, comparative data addressing the efficacy and safety of MCO dialyzers vs. postdilution hemodiafiltration (HDF) in Korean patients are lacking. Nine patients with chronic HD were included in this pre-post study. Patients underwent HD with an MCO dialyzer for 4 weeks, followed by a 2-week washout period using a high-flux dialyzer to minimize carryover effects, and then turned over to postdilution HDF for 4 weeks. Reduction ratios and differences in the uremic toxins before and after dialysis were calculated from the MCO dialysis, postdilution HDF, and high-flux HD. In the in vitro study, EA.hy926 cells were incubated with dialyzed serum. Compared to postdilution HDF, the MCO dialyzer achieved significantly higher reduction ratios for larger middle molecules (myoglobin, kappa free light chain [κFLC], and lambda FLC [λFLC]). Similarly, the differences in myoglobin, κFLC, and λFLC concentrations before and after the last dialysis session were significantly greater in MCO dialysis than in postdilution HDF. The expression of Bax and nuclear factor κB was decreased in the serum after dialysis with the MCO dialyzer than with HDF. Compared with high-volume postdilution HDF, MCO dialysis did not provide greater removal of molecules below 12,000 Da, whereas it was superior in the removal of larger uremic middle molecule toxins in patients with kidney failure. Moreover, these results may be expected to have an anti-apoptotic effect on the human endothelium.

Comparison of four medium cut-off dialyzers.

Comparison of four medium cut-off dialyzers.

Reply to "Comparison of four medium cut-off dialyzers".

Reply to "Comparison of four medium cut-off dialyzers".

Comparison of 2 medium cutoff dialyzers versus on-line hemodiafiltration regarding depurative ability and albumin loss: An uncontrolled clinical research.

Hemodialysis (HD) techniques that best remove molecules in the middle to high molecular weight range are on-line hemodiafiltration (OL-HDF) and HD with medium cut-off (MCO) membranes. The aim of this study was to compare efficacy and safety of OL-HDF with FxCordiax HDF 800™, with HD with 2 MCO dialyzers: Theranova 500® and the new Elisio 21HX™ dialyzer. Fourteen patients following treatment with OL-HDF using FxCordiax HDF 800™ were randomized to receive a consecutive 1-week HD treatment with Theranova 500® and Elisio 21HX™.The reduction rate (RR) of differently sized molecules was compared, as well as the variation rate in molecules smaller than 1000, detected by nuclear magnetic resonance based chemometrics (metabolomics). Albumin loss in dialysate was quantified. Lower RRs were found for molecules around 20 000 with Elisio 21HX™ compared to OL- HDF (RR prolactin 58.5% versus 66.7%, p=0.034; RR Kappa light chain 63.1% versus 71.8%, p=0.010). Albumin loss per session was higher with Theranova 500® than with OL-HDF and with Elisio 21HX™ (2249.9 ± 714.1mg, 815.2 ± 474.0mg, 442.9 ± 135.9mg, p < 0.001, respectively). Metabolomic studies suggested, by semi-quantitative analysis, a greater depurative capacity of OL-HDF, followed by Elisio 21HX™, and then Theranova 500®. In this study, HD with Theranova 500® has proven to be very similar in efficacy to OL-HDF, although with a significantly higher albumin loss. HD with Elisio 21HX™ resulted in lower removal of molecules around 20 000 compared to OL-HDF, with no significant difference compared to Theranova 500®, and with less albumin loss than Theranova 500®.

EE96 Budget-Impact Analysis of Adopting Expanded Hemodialysis (HDX) Via Theranova® in Korea

HD (Hemodialysis) is the dominant modality among ESRD patients in Korea, so the role of dialyzer is quite important for treatment outcomes. Theranova® (dialyzer of expanded hemodialysis, HDx) is a medium cut-off dialyzer that allows for better clearance of large middle molecules than traditional high-flux dialyzers. Compared to high flux HD, HDx via Theranova® has been associated with reduced treatments for anemia and lower risk of all-cause and cardiovascular hospitalization. This budget impact analysis evaluates healthcare costs aligned with clinical factor between Theranova® and conventional hemodialysis (HD) with a high-flux dialyzer in Korea.

Evaluation of VIE-X Filter Performances vs. Medium Cut-Off Dialyzer and High-Flux Dialyzers on Protein Loss and Inflammatory Status of Chronic Hemodialysis Patients

Evaluation of VIE-X Filter Performances vs. Medium Cut-Off Dialyzer and High-Flux Dialyzers on Protein Loss and Inflammatory Status of Chronic Hemodialysis Patients

Improved Removal of Free Light Chains by Hemodialysis With Medium Cut-Off Dialyzer

Improved Removal of Free Light Chains by Hemodialysis With Medium Cut-Off Dialyzer

Use of Medium Cut-Off Dialyzers in AKI Associated With Multiple Myeloma

Use of Medium Cut-Off Dialyzers in AKI Associated With Multiple Myeloma

Comparison of four medium cut-off dialyzers.

Recently, several pharmaceutical companies have developed new medium cut-off (MCO) dialyzers for expanded hemodialysis (HDx). This study aimed to compare the safety and efficacy of four MCO dialyzers, against each other and versus high-flux hemodialysis (HD) and post-dilution hemodiafiltration (HDF). A prospective study was carried out on 23 patients who underwent six dialysis sessions: two sessions with the FX80 Cordiax in HD and HDF, and four HDx sessions with the Phylther 17-SD, Vie-18X, Elisio HX19 and Theranova 400 dialyzers. The reduction ratios (RRs) of urea, creatinine, β2-microglobulin, myoglobin, kappa free immunoglobulin light chain (κFLC), prolactin, α1-microglobulin, α1-acid glycoprotein, lambda (λFLC) and albumin were compared. Dialysate albumin loss was also measured. The differences in efficacy between the evaluated dialyzers were minimal in small molecules and even up to the size of β2-microglobulin. The main differences were found between myoglobin, κFLC, prolactin, α1-microglobulin and λFLC RRs, in which all four MCO dialyzers, with similar efficacy, were clearly superior to HD and slightly inferior to HDF treatment. Albumin losses in the dialysate with HD dialyzers were <1 g and between 1.5 and 2.5 g in HDx and HDF. The global removal score values were similar in all four HDx treatments, and again significantly higher than those with HD. The results of the four MCO dialyzers evaluated in this study showed good efficiency, with no significant performance differences between them while being completely safe in terms of albumin loss. Likewise, the study confirms the superiority of HDx over high-flux HD with an efficacy close to that of post-dilution HDF.

MO642: Comparison of Medium Cut-Off Dialyzer and Post-Dilution Hemodiafiltration on the Removal of Small and Middle Molecule Uremic Toxins

Abstract BACKGROUND AND AIMS The medium cut-off (MCO) dialyzer increases the removal of several middle molecules more effectively than high-flux hemodialysis (HD). However, there are no comparable data on the efficacy and safety of MCO dialyzers versus post-dilution hemodiafiltration (HDF) in Korean patients. METHOD A total of 9 patients with chronic HD were included in this crossover study. Patients received HD with an MCO dialyzer for 4 weeks, followed by a 2-week washout period, using a high-flux dialyzer to minimize carry-over effects and then crossed over to post-dilution HDF for 4 weeks. Reduction ratios and differences in the values before and after were calculated from the MCO dialysis, post-dilution HDF and high-flux HD. In the in vitro study, EA.hy926 cells were treated with dialyzed serum. RESULTS Compared with post-dilution HDF, the MCO dialyzer achieved significantly higher reduction ratios for larger middle molecules [myoglobin, kappa free light chain (κFLC) and lambda FLC (λFLC)]. Similarly, the differences between before and after the last dialysis session of myoglobin, κFLC, and λFLC were significantly greater in MCO dialysis than in post-dilution HDF. The expression of Bax and nuclear factor-κb was decreased in the serum after dialysis with the MCO dialyzer than with HDF. CONCLUSION Compared with high-volume post-dilution HDF, MCO dialysis showed no differences in the removal of molecules below 12 000 Da, whereas it was superior in the removal of larger uremic middle molecule toxins in patients with kidney failure. Moreover, these results might be expected to have an anti-apoptotic effect on the human endothelium.

Economic evaluation of expanded hemodialysis with the Theranova 400 dialyzer: A post hoc evaluation of a randomized clinical trial in the United States.

IntroductionThe Theranova 400 is a medium cut‐off dialyzer that allows for superior clearance of larger middle molecules than traditional high‐flux dialyzers. This study evaluates the association of expanded hemodialysis (HDx) using the Theranova dialyzer versus conventional hemodialysis (HD) with a high‐flux dialyzer on hospitalization rates and healthcare costs as compared to conventional HD in a post hoc analysis of a randomized controlled trial.MethodsIn a non‐concealed, 24‐week clinical trial, maintenance HD patients were randomized to receive treatment with either Theranova 400 or a similar size high‐flux dialyzer. Hospitalization rate and average length of stay were calculated from trial data. Use of erythropoiesis‐stimulating agents and iron were assumed to be equal and therefore excluded from the model. Average cost per inpatient day was obtained from a publicly available published source. Probabilistic sensitivity analyses were conducted to account for variability in model inputs.FindingsThere were 86 patients (389 patient‐months) in the Theranova group and 85 patients (366 patient‐months) in the high‐flux HD group. All‐cause hospitalization rate was 45% lower with Theranova compared to high‐flux HD (IRR = 0.55; p = 0.05). Average annual estimated cost of hospitalization was $6098 lower with Theranova compared to high‐flux HD. Compared to high‐flux HD, average annual estimated cost associated with Theranova use was $4772 lower per patient. Hospitalization rate and hospital length of stay were the main drivers of cost.ConclusionsUse of the Theranova dialyzer is associated with lower estimated costs of care among maintenance HD patients, driven by fewer hospitalization events.