Use Of High-flux Dialyzer Research Articles

Performance and Self-Perceived Restless Leg Syndrome Associated with Use of High-Flux Dialyzers: Results from the eMPORA III Trial

Performance and Self-Perceived Restless Leg Syndrome Associated with Use of High-Flux Dialyzers: Results from the eMPORA III Trial

Real-World Performance of High-Flux Dialyzers in Patients With Hypoalbuminemia.

There is little research on factors that influence the choice of dialyzer in patients undergoing hemodialysis. In patients at risk for poorer outcomes, including those with hypoalbuminemia, understanding how this choice impacts clinical parameters could inform patient management. The objective of this real-world analysis was to evaluate the use and performance of four single-use (i.e., nonreuse [NR]), high-flux Optiflux dialyzers with varying surface areas (F160NR [1.5 m2], F180NR [1.7 m2], F200NR [1.9 m2], and F250NR [2.5 m2]) in patients (N = 271) with baseline hypoalbuminemia (≤3.5 g/dl) receiving hemodialysis at a medium-sized dialysis organization. Thrice weekly, in-center dialysis was delivered for 6 months without adjustments to the hemodialysis prescription. Larger dialyzers were more frequently used in men, patients with higher body mass indices, and those with diabetes. Increases in serum albumin from baseline (month 1) to month 6 (p < 0.05) were observed with all dialyzer sizes. A mean increase in hemoglobin of 0.31 g/dl was also observed (p < 0.001). Among patients exhibiting increased serum albumin levels (n = 177), reductions in the neutrophil-to-lymphocyte ratio, a marker of inflammation, were observed (mean: 0.90; p < 0.001). These results support the use of high-flux dialyzers in patients with hypoalbuminemia.

Comparison the effect of high flux and low flux dialyzer on quality of life in hemodialysis patients; a clinical trial

Introduction: End-stage renal disease (ESRD) is a worldwide public health problem. ESRD reduces health-related quality of life. Quality of life is an important determinant in the mortality and morbidity of hemodialysis patients. However, several studies have suggested that high flux dialyzers increase dialysis adequacy and reduce mortality and morbidity in these patients. Objectives: This study aimed to investigate the effects of high flux and low flux dialyzers on the quality of life in hemodialysis patients. Patients and Methods: In this clinical trial, 93 patients who met the inclusion criteria were randomly assigned to two groups of high flux and low flux dialyzers. Before intervention, both groups filled demographic and quality of life questionnaires. They were undergone dialysis with two dialyzers (one group by high flux and another by low flux) three times a week for 6 weeks. Then quality of life questionnaire was filled by both groups once again. Results: The overall quality of life score was not significantly different in both groups before intervention (P=0.121). After intervention, however, high flux group attained a significantly higher mean score (54 ± 10.4) than low flux group (43.89 ± 11.64) (P&lt;0.001). Conclusion: According to the results of this study, the use of high flux dialyzers can be a useful method to increase the quality of life in hemodialysis patients.

Dialyzer Reuse and Outcomes of High Flux Dialysis.

BackgroundThe bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers.MethodsProportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO.FindingsIn HEMO, minimally reused (< 6 times) HF dialyzers were associated with a hazard ratio (HR) of 0.67 (95% confidence interval, 95%CI: 0.48–0.92, p = 0.015), 0.64 (95%CI: 0.44 – 0.95, p = 0.03), 0.61 (95%CI: 0.41 – 0.90, p = 0.012), 0.53 (95%CI: 0.28 – 1.02, p = 0.057) relative to minimally reused LF ones for all cause, cardiovascular, cardiac and infectious mortality respectively. These relationships reversed for extensively reused membranes (p for interaction between reuse and flux < 0.001, p = 0.005) for death from all cause and cardiovascular causes, while similar trends were noted for cardiac and infectious mortality (p of interaction between reuse and flux of 0.10 and 0.08 respectively). Reduction of β2M explained only 1/3 of the effect of minimally reused HF dialyzers on all cause mortality, while non-β2M related factors explained the apparent attenuation of the benefit with more extensively reused dialyzers. Meta-regression of HEMO and MPO estimated an adjusted HR of 0.63 (95% CI: 0.51–0.78) for non-reused HF dialyzers compared with non-reused LF membranes.ConclusionsThis secondary analysis and synthesis of two large hemodialysis trials supports the widespread use of HF dialyzers in clinical hemodialysis over the last decade. A mechanistic understanding of the effects of HF dialysis and the reuse process on dialyzers may suggest novel biomarkers for uremic toxicity and may accelerate membrane technology innovations that will improve patient outcomes.

Online hemodiafiltration – A systematic review

Abstract The survival of patients on hemodialysis is very poor when compared to kidney transplantation. Several attempts have been made to improve the survival of dialysis patients. Some such attempts are more frequent dialysis, more prolonged dialysis, use of high flux dialyzers, use of ‘ultrapure’ dialysate, and better electrolyte and mineral metabolism. Hemodiafiltration is one such measure, where both diffusive and convective methods of toxin removal are exploited with a view of removing both small molecular weight and larger molecular weight toxins from the body. Over last 2 decades several studies with confronting results regarding hemodiafiltration and survival outcome are published and hence need for a review.

Uremic Pruritus, Dialysis Adequacy, and Metabolic Profiles in Hemodialysis Patients: A Prospective 5-Year Cohort Study

BackgroundUremic pruritus is a common and intractable symptom in patients on chronic hemodialysis, but factors associated with the severity of pruritus remain unclear. This study aimed to explore the associations of metabolic factors and dialysis adequacy with the aggravation of pruritus.MethodsWe conducted a 5-year prospective cohort study on patients with maintenance hemodialysis. A visual analogue scale (VAS) was used to assess the intensity of pruritus. Patient demographic and clinical characteristics, laboratory parameters, dialysis adequacy (assessed by Kt/V), and pruritus intensity were recorded at baseline and follow-up. Change score analysis of the difference score of VAS between baseline and follow-up was performed using multiple linear regression models. The optimal threshold of Kt/V, which is associated with the aggravation of uremic pruritus, was determined by generalized additive models and receiver operating characteristic analysis.ResultsA total of 111 patients completed the study. Linear regression analysis showed that lower Kt/V and use of low-flux dialyzer were significantly associated with the aggravation of pruritus after adjusting for the baseline pruritus intensity and a variety of confounding factors. The optimal threshold value of Kt/V for pruritus was 1.5 suggested by both generalized additive models and receiver operating characteristic analysis.ConclusionsHemodialysis with the target of Kt/V ≥1.5 and use of high-flux dialyzer may reduce the intensity of pruritus in patients on chronic hemodialysis. Further clinical trials are required to determine the optimal dialysis dose and regimen for uremic pruritus.

Serum myostatin levels and grip strength in normal subjects and patients on maintenance haemodialysis

Myostatin, a negative regulator of skeletal muscle growth, may modulate grip strength, an indicator of muscle function. Its serum levels could be modulated by maintenance haemodialysis (MHD). A descriptive cross-sectional study. Forty-one normal controls and 60 MHD patients using different dialyzers at a medical centre. The grip strength of the dominant hand, body composition, and the predialysis and postdialysis serum myostatin and IGF-1 levels were measured. The MHD patients had lower body mass index, IGF-1 level, and grip strength than the normal controls. The patients using the high-flux dialyzer had better grip strength than those using the low-flux dialyzer (25·5 vs 19·2 kg). The predialysis myostatin level was higher in low-flux dialyzer than high-flux dialyzer (31·0 vs 18·5 μg/ml). Interestingly, the high-flux dialyzer reduced the serum myostatin by 36%, whereas low-flux dialyzer increased it by 25%. The myostatin was inversely related to age and the use of high-flux dialyzer. Furthermore, the grip strength was negatively related to age, female gender, muscle mass, myostatin levels and haemodialysis, but positively to the use of high-flux dialyzer in linear regression. The risk of low grip strength was 7·6 times higher in those with higher serum myostatin with the adjustment of age, gender, muscle mass, haemodialysis and mode of dialysis in a logistic regression. The mode of dialyzer modulates the blood levels of myostatin. Higher myostatin is associated with lower muscle function. The use of myostatin assay in various clinical settings merits further investigation.

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CHAPTER 1

Neonatal Hemodialysis and Continuous Renal Replacement Therapy

After completing this article, readers should be able to: 1. Describe catheters, dialyzers, and blood lines in hemodialysis for neonates. 2. Explain the blood prime and hemodialysis prescription in hemodialysis for neonates. 3. List potential complications of hemodialysis for neonates. 4. Identify the types of continuous renal replacement therapy (CRRT) in neonates. 5. Explain the dialysis prescription and anticoagulation options for CRRT in neonates. 6. List potential complications of CRRT in neonates. Since the mid-1980s, when dialysis manufacturers began making dialyzers and blood circuit paths that required smaller extracorporeal volumes, hemodialysis has been used successfully to manage renal failure in neonates and infants. Compared with peritoneal dialysis (PD), which is analogous to the “family sedan” in the world of dialysis (slower, more predictable, easier to operate), hemodialysis is the “race car.” Hemodialysis is capable of removing fluids and solutes much more rapidly than is PD. Unlike PD, hemodialysis uses catheters that access the intravascular space directly. Despite the advantages of hemodialysis, the process in neonates is technically more challenging than PD due to the very attributes that make it so effective. Rapid removal of intravascular fluids, exceeding the rate of refill from the extravascular space, causes problems with hypotension due to direct reduction in intravascular volume. Similarly, rapid rates of solute clearance can cause problems with increased intracranial pressure. Catheter placement and maintenance of catheter function can constitute a significant obstacle to hemodialysis. Hemofiltration is very similar to hemodialysis in that patient blood is circulated through an artificial kidney. However, hemofiltration differs from hemodialysis in three significant aspects. First, the hemofilter has larger pore sizes than the standard dialyzer, which allows for excellent fluid removal, even with low blood flow rates, and better larger molecule clearance. Second, hemofiltration runs continuously without the continuous presence of a dialysis nurse. Third, typical hemofiltration uses a pre- or postdilution …

The Effect of High-Flux Hemodialysis on Dialysis-Associated Amyloidosis

Amyloidosis is an important cause of mortality and morbidity in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). In this study, depending on the idea that the clearance of middle and high molecular weight toxins could be improved, we aimed to investigate the effect of high-flux dialyzer on clearance of beta-2 microglobulin (β2-MG) and calcium (Ca) phosphorus (P) metabolism in patients under HD treatment. Forty-eight patients with ESRD under chronic HD treatment were included in the study. All patients were randomized into two groups, and HD was performed with low-flux or high-flux dialyzer for 6 months. In the high-flux group, the reduction of β2-MG and P levels during dialysis was significantly higher when compared with the low-flux group (p < 0.001). During the follow-up period, while β2-MG levels decreased significantly in the high-flux group (p < 0.05), there was an increase in the low-flux group (p < 0.05). As a result, our findings suggest that use of high-flux dialyzer can be an efficient alternative in terms of controlling the clearance of β2-MG and impaired Ca and P metabolism. These beneficial effects of high-flux dialyzers are probably mediated by the improved clearance of middle and high molecular weight toxins.

Dose of dialysis: Key lessons from major observational studies and clinical trials

Dose of dialysis: Key lessons from major observational studies and clinical trials