Clinical Safety of Expanded Hemodialysis Compared with Hemodialysis Using High-Flux Dialyzer during a Three-Year Cohort

Abstract

Expanded hemodialysis (HD) equipped with a medium cut-off (MCO) membrane provides superior removal of larger middle molecules. However, there is still little research on the long-term benefits of expanded HD. Over a three-year period, this observational study evaluated the efficacy and safety profile of expanded HD for inflammatory cytokines, including IL-6. We conducted a prospective cohort study to investigate the inflammatory cytokine changes and a retrospective observational cohort study to investigate long-term clinical efficacy and safety over a three-year period. We categorized the patients according to dialyzer used: MCO and high-flux (HF) dialyzer. The inflammatory cytokines, including IFN-γ, IL-1β, IL-6, and TNF-α, were measured annually. The concentrations and changes of the four cytokines over time did not differ between the HF group (n = 15) and MCO group (n = 27). In both prospective and retrospective (HF group, n = 38; MCO group, n = 76) cohorts, there were no significant differences in either death, cardiovascular events, infections, or hospitalizations. Furthermore, the temporal changes in laboratory values, including serum albumin and erythropoietin prescriptions, did not differ significantly between the two groups in either the prospective or retrospective cohorts. In conclusion, clinical efficacy and safety outcomes, as well as inflammatory cytokines, did not differ with expanded HD compared with HF dialysis during a three-year treatment course, although the level of inflammatory cytokine was stable.

Could cooling dialysate improve inflammatory and nutritional status of hemodialysis patients?

“…These findings hamper the inflammatory suppressive role of individualized dialysate cooling. Other studies involving hemodialysis [ 34 ] and peritoneal dialysis [ 35 ] patients found a tendency for IL-6 levels to remain stable over 3 and 1 years of follow-up, respectively. The shorter duration of follow-up in the present study, as well as the distinct dialysis modalities of extended hemodialysis and peritoneal dialysis, may account for these contradictory findings.…”

Theranova versus FX80: The impact on anemia management in hemodialysis

“…16 A 3-year follow-up observational study involving 42 patients, reported no difference in darbepoetin alfa use between MCO and high-flux dialysis. 17 The potential benefits of improved removal of MUTs on ESA dose and ERI have been observed with online hemodiafiltration. 18 In a small, 6-month randomized controlled study that compared Theranova 500 with hemodiafiltration (which is considered superior to high-flux hemodialysis in removing MUTs), the Theranova group showed evidence of better MUT clearance and a statistically non-significant downward trend in weekly ESA dosing and lower ERI, while hemoglobin levels remained stable.…”

Extracorporeal Techniques in Kidney Failure

“…4). This allows augmented clearances of molecules in a very broad spectrum [38,40], without significant losses of albumin [41]. Several studies suggest an improved erythropoietin responsiveness [42,43], improved muscle strength, improved nutritional status in parallel to a reduction of chronic inflammation [44].…”