Current approaches to middle molecule removal: room for innovation

Masakane, Ikuto; Sakurai, Katsunobu

doi:10.1093/ndt/gfy224

Cited by 72 publications

(70 citation statements)

References 76 publications

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“…In general, dialysers are assigned into one of four categories according to the degree of removal of molecules such as beta‐2 microglobulin and albumin: Ia, Ib, IIa and IIb . In this study, the dialysers were divided into two categories, Ia plus IIa and Ib plus IIb, according to removal of large molecules such as albumin.…”

Section: Methodsmentioning

confidence: 99%

The efficacy and safety of glecaprevir plus pibrentasvir in 141 patients with severe renal impairment: a prospective, multicenter study

Atsukawa¹,

Tsubota²,

Toyoda³

et al. 2019

Aliment Pharmacol Ther

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Background: Patients with chronic hepatitis C are often complicated by chronic kidney disease (CKD).Aim: To evaluate the efficacy, safety and pharmacokinetics of glecaprevir/pibrentasvir in patients with severe renal impairment. Methods:In a prospective, multicentre study involving 35 medical institutions, 832 genotype 1-3 patients were treated with glecaprevir/pibrentasvir. The efficacy and safety of glecaprevir/pibrentasvir were analysed for patients with CKD stage 4 or 5.Multivariate analysis was performed to identify the factors associated with the most frequently observed adverse event. In patients undergoing haemodialysis, a pharmacokinetic study was conducted to investigate the dialysability of the drugs: plasma samples were obtained from the arterial and venous sides of a dialyser to serially measure drug concentrations. Results:The subjects comprised 141 patients (32 with CKD stage 4 and 109 with CKD stage 5), of whom 100 were undergoing haemodialysis. All but one stage 5 CKD patients undergoing haemodialysis achieved sustained virologic response (99.3%). Adverse events were observed in 39.7% of subjects: pruritus was the most frequent (30.5%), and was significantly associated with haemodialysis. In the pharmacokinetic study, no arterial-venous differences in the plasma concentrations of glecaprevir/pibrentasvir were detected during the haemodialysis sessions.Masanori Atsukawa, Akihito Tsubota and Hidenori Toyoda contributed equally to the preparation of this manuscript. The complete list of affiliations is listed in Appendix 1.

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Section: Methodsmentioning

confidence: 99%

The efficacy and safety of glecaprevir plus pibrentasvir in 141 patients with severe renal impairment: a prospective, multicenter study

Atsukawa¹,

Tsubota²,

Toyoda³

et al. 2019

Aliment Pharmacol Ther

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“…The predilution method can freely increase the substitution volume even with a low blood flow rate and is able to improve the solute removal efficiency of low molecular weight proteins (LMWPs). Furthermore, if we use a large pore size filter in the predilution method, we can remove larger LMWPs without explosive albumin leakage [5]. The Japanese pioneer doctors found that dialysis prescriptions with larger LMWP removal incurring a certain level of albumin loss have improved various uremic symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…The Japanese pioneer doctors found that dialysis prescriptions with larger LMWP removal incurring a certain level of albumin loss have improved various uremic symptoms. Based on these experiences, "protein permeable dialysis" has developed in Japan [5,6].…”

Section: Introductionmentioning

confidence: 99%

Multipotentials of new asymmetric cellulose triacetate membrane for on-line hemodiafiltration both in postdilution and predilution

Tanaka¹,

Michiwaki²,

Asa³

et al. 2019

Ren Replace Ther

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Background: On-line hemodiafiltration (OL-HDF) has been generally provided mainly by the postdilution method in Europe and the rest of the world; however, in Japan, it has been provided mostly by the predilution method in order to ameliorate dialysis-related symptoms of dialysis patients by removing larger low molecular weight proteins. This study aimed to elucidate the removal properties of a newly launched asymmetric triacetate (ATA) membrane in OL-HDF both in the postdilution and predilution comparison with other synthetic polymer membranes. Methods: Six patients treated by OL-HDF at the Kawashima Hospital Group were randomly chosen for each membrane study. The removal properties of low molecular weight proteins were evaluated by β 2-microglobulin (β 2-MG), α 1microglobulin (α 1-MG), albumin leakage, selective removal index of α 1-MG for albumin, and transmembrane pressure for each treatment group. Two types of ATA membrane were evaluated in the study: FIX-S with mild protein permeability and FIX-U with higher protein permeability in the comparisons with other three types of synthetic polymer membranes. Results: The removal rate of β 2-MG showed almost no significant differences between the postdilution and predilution methods in most membrane groups at around 75-80% without relations to the membrane material and the substitution volume. The removal rates of α 1-MG were markedly different depending on the dilution method of HDF, the membranes, and the substitution volume. Generally, the removal rates of α 1-MG were better in the postdilution than the predilution but the selective removals of α 1-MG were better in the predilution. The high volume OL-HDF had the risk of excessive albumin leakage in a certain membrane choice. In the FIX series, the removal rates of α 1-MG were sufficient both in the postdilution and predilution with the increase of the substitution volume with suppressing the albumin leakage during the dialysis session. Especially, FIX-U showed higher removal of α 1-MG with suppressing the albumin leakage. Conclusions: The newly launched ATA membrane could remove α 1-MG, selectively suppressing the excessive albumin leakage and increasing the substitution volume safely even in high-volume postdilution.

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“…However, the risk of depletion of important nutrients during dialysis sessions with highly permeable membranes cannot be ruled out, and, while the advantages of better depuration are clear in young, well-nourished patients, it is still far from certain that high flow hemodiafiltration produces advantages for malnourished patients [26][27][28][29][30][31][32][33].…”

Section: Lipidsmentioning

confidence: 99%

“…Moreover, dialysis prescription varies widely, and very different treatments may be gathered under the same name; information on the dialysis schedule is often incomplete, thus making comparisons and implementing strategies can be challenging [29][30][31].…”

Section: Mia: Malnutrition Inflammation Atherosclerosis Syndromementioning

confidence: 99%

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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Current approaches to middle molecule removal: room for innovation

Cited by 72 publications

References 76 publications

The efficacy and safety of glecaprevir plus pibrentasvir in 141 patients with severe renal impairment: a prospective, multicenter study

The efficacy and safety of glecaprevir plus pibrentasvir in 141 patients with severe renal impairment: a prospective, multicenter study

Multipotentials of new asymmetric cellulose triacetate membrane for on-line hemodiafiltration both in postdilution and predilution

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

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