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Randomized Controlled Trial
. 2017 Jan 1;32(1):165-172.
doi: 10.1093/ndt/gfw310.

Performance of hemodialysis with novel medium cut-off dialyzers

Alexander H Kirsch  1 , Raphael Lyko  2 , Lars-Göran Nilsson  3 , Werner Beck  4 , Michael Amdahl  5 , Petra Lechner  6 , Andreas Schneider  2 , Christoph Wanner  2 , Alexander R Rosenkranz  1 , Detlef H Krieter  2
Affiliations
Randomized Controlled Trial

Performance of hemodialysis with novel medium cut-off dialyzers

Alexander H Kirsch et al. Nephrol Dial Transplant. .

Erratum in

Abstract

Background: Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules.

Methods: In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments.

Results: MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF.

Conclusions: MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC.

Keywords: beta2-microglobulin; dialysis; hemodiafiltration; hemodialysis; uremic toxins.

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Figures

FIGURE 1
FIGURE 1
Free immunoglobulin light chain removal during hemodialysis with medium cut-off dialyzers and high-flux dialyzers in study 1. (A) Overall clearance. (B) Reduction ratio. Data are least square mean ± standard error. FLC, free light chain; MCO, medium cut-off dialyzer. *P < 0.001, compared to high-flux dialyzer.
FIGURE 2
FIGURE 2
Free immunoglobulin light chain removal during hemodialysis with medium cut-off dialyzers and high-flux dialyzers and hemodiafiltration in study 2. (A) Overall clearance. (B) Reduction ratio. Data are least square mean ± standard error. FLC, free light chain; HD, hemodialysis; HDF, hemodiafiltration; MCO, medium cut-off dialyzer. *P < 0.001, compared to high-flux HD; **P < 0.001, compared to HDF; ***P = 0.01, compared to HDF.
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