A Pilot, Randomized, Double-Blind, Cross-Over Study of High Cut-Off versus High-Flux Dialysis Membranes

Abstract

Background: High cut-off (HCO) membranes may increase β₂-microglobulin (β2M) removal compared to standard high-flux membranes.Methods:Eight stable haemodialysis patients were enrolled in a prospective, randomized, double-blind, cross-over study and treated with HCO and high-flux membranes for 2 weeks each, between a 1-week washout period. Primary end point was serum β2M removal. Secondary end points included serum albumin concentrations, albumin and small solute clearances. Results: HCO membranes achieved significantly lower median post-dialysis β2M concentration (10.8 vs. 14.2 mg/l; p = 0.003) and greater β2M reduction ratio (62.3 vs. 51.0%; p < 0.002). Serum albumin decreased with HCO membranes (from 36 to 29.5 g/l; p = 0.018) but increased to 33.5 g/l after the washout period. Albumin clearance was significantly greater with HCO membranes (2.2 vs. 0.06 ml/min; p = 0.004). Urea reduction ratio was significantly lower with HCO membranes (64.8 vs. 71.5%; p < 0.001). Conclusion: β2M removal was superior with HCO membranes. Reduction in serum albumin and lower small solute clearance require further investigations.

Clinical review: Blood purification for sepsis

“…While some decreases in plasma cytokine levels were even reported after only 4 hours of treatment, the albumin loss was limited and plasma albumin concentrations remained stable. Conversely, Lee and colleagues [76] recently highlighted reductions in serum albumin levels after HCO hemodialysis sessions, leaving this question open to further clinical investigation. To address this issue, membrane parameters and aspects other than the type of modality (diffusion versus convection) - for example, membrane homogeneity in terms of pore size, membrane surface, the use of super-high-flux hemofilters that have a slightly lower cutoff, and the use of the association HVHF-high permeability - certainly need to be taken into account [69].…”

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

“…Bakulev NSPCCS in 2009-2016, showed the safety and efficacy of the combined therapies mentioned above. [53,54] We observed that the combination of LPS-adsorption and HDF filters with high cut-off EMiC2 membranes led to a 34% MAP increase [from 76 (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81) to 90 (85-102) mmHg, P < 0.001] with reduced vasopressor and inotropic support. The increase in MAP during LPS-adsorption with CPFA was 12% with the significant decrease in vasopressor support [the dose of noradrenaline was halved from 0.2 (0.15-0.3) to 0.1 (0.05-0.15) µg/kg/min, P = 0.024].…”

“…The permeability of these filters is similar to that of the kidney glomerular basement membrane, suggesting that the therapeutic effect of HDF is more physiological. [66,[71][72][73] Several studies have demonstrated the beneficial effect of selective LPS-adsorption, HD/HDF (with high cut-off membranes) and CPFA in sepsis. [58,[64][65][66] We proposed two new techniques of combined blood purification methods in single circuit: (1) LPS-adsorption + HDF using filters with high cutoff membranes; and (2) LPS-adsorption + CPFA.…”

The Evolving Patterns of Uremia: Unmet Clinical Needs in Dialysis

“…However, most patients can stand such degree of albumin loss in a short-term period, or with corresponding quantity of albumin supplementation. Additionally, the reverse osmosis of endotoxin or reverse ultrafiltration from dialysis solution could be increased due to the 2-3 times larger membrane aperture of HCO as compared with high-flux membrane [15,17] . The clearance of uremic toxin increases, while the loss of albumin has become a major obstacle for both PLMs and HCO in clinical application.…”