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Removal of large middle molecules via haemodialysis with medium cut-off membranes at lower blood flow rates: an observational prospective study.


ABSTRACT: BACKGROUND:Online haemodiafiltration (OL-HDF) may improve middle molecular clearance in contrast to conventional haemodialysis (HD). However, OL-HDF requires higher convective flows and cannot sufficiently remove large middle molecules. This study evaluated the efficacy of a medium cut-off (MCO) dialyser in removing large middle molecular uraemic toxins and compared it with that of conventional high-flux (HF) dialysers in HD and predilution OL-HDF. METHODS:Six clinically stable HD patients without residual renal function were investigated. Dialyser and treatment efficacies were examined during a single midweek treatment in three consecutive periods: 1) conventional HD using an HF dialyser, 2) OL-HDF using the same HF dialyser, and 3) conventional HD using an MCO dialyser. Treatment efficacy was assessed by calculating the reduction ratio (RR) for ?2-microglobulin (?2M), myoglobin, ? and ? free light chains (FLCs), and fibroblast growth factor (FGF)-23 and measuring clearance for FLCs. RESULTS:All three treatments showed comparable RRs for urea, phosphate, creatinine, and uric acid. MCO HD showed greater RRs for myoglobin and ?FLC than did HF HD and predilution OL-HDF (myoglobin: 63.1?±?5.3% vs. 43.5?±?8.9% and 49.8?±?7.3%; ?FLC: 43.2?±?5.6% vs. 26.8?±?4.4% and 33.0?±?9.2%, respectively; P?

SUBMITTER: Kim TH 

PROVIDER: S-EPMC6937993 | BioStudies | 2019-01-01

REPOSITORIES: biostudies

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