Effects of Hemodialysis Therapy Using Dialyzers with Medium Cut-Off Membranes on Middle Molecules

Kirsch, Alexander H.; Rosenkranz, Alexander R.; Lyko, Raphael; Krieter, Detlef H.

doi:10.1159/000479264

Cited by 24 publications

(26 citation statements)

References 6 publications

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“…In two recent pilot studies, the effects of HD therapy using an MCO dialyzer (MCO HD) was compared to (a) high-flux HD, and (b) high-flux HD and HDF [ 112 ]. The primary outcome was the clearance of overall free immunoglobulin light chains (lambda FLC) while the clearance of other middle molecules and safety was the secondary outcome.…”

Section: Therapeutic Interventionsmentioning

confidence: 99%

Gut Microbiota and Cardiovascular Uremic Toxicities

Velasquez

Centron

Barrows

et al. 2018

Toxins

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Cardiovascular disease (CVD) remains a major cause of high morbidity and mortality in patients with chronic kidney disease (CKD). Numerous CVD risk factors in CKD patients have been described, but these do not fully explain the high pervasiveness of CVD or increased mortality rates in CKD patients. In CKD the loss of urinary excretory function results in the retention of various substances referred to as “uremic retention solutes”. Many of these molecules have been found to exert toxicity on virtually all organ systems of the human body, leading to the clinical syndrome of uremia. In recent years, an increasing body of evidence has been accumulated that suggests that uremic toxins may contribute to an increased cardiovascular disease (CVD) burden associated with CKD. This review examined the evidence from several clinical and experimental studies showing an association between uremic toxins and CVD. Special emphasis is addressed on emerging data linking gut microbiota with the production of uremic toxins and the development of CKD and CVD. The biological toxicity of some uremic toxins on the myocardium and the vasculature and their possible contribution to cardiovascular injury in uremia are also discussed. Finally, various therapeutic interventions that have been applied to effectively reduce uremic toxins in patients with CKD, including dietary modifications, use of prebiotics and/or probiotics, an oral intestinal sorbent that adsorbs uremic toxins and precursors, and innovative dialysis therapies targeting the protein-bound uremic toxins are also highlighted. Future studies are needed to determine whether these novel therapies to reduce or remove uremic toxins will reduce CVD and related cardiovascular events in the long-term in patients with chronic renal failure.

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Section: Therapeutic Interventionsmentioning

confidence: 99%

Gut Microbiota and Cardiovascular Uremic Toxicities

Velasquez

Centron

Barrows

et al. 2018

Toxins

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show abstract

“…However, since no replacement solution or elevated ultrafiltration rates are needed to perform the therapy, this implies a practical benefit over the currently used HDF techniques, where high volumes of replacement fluid are needed to achieve significantly different outcomes. Indeed, the first reports show comparable or even superior results of HDx compared with HDF, with a simpler treatment and less technical requirements [ 51 , 52 ]. In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent HD patients were studied in four dialysis treatments with medium cut-off (MCO) prototype dialysers and high-flux dialysers.…”

Section: Introductionmentioning

confidence: 99%

Chronic inflammation in end-stage renal disease and dialysis

Cobo

Lindholm

Stenvinkel

2018

Nephrology Dialysis Transplantation

297

233

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Under normal conditions, inflammation is a protective and physiological response to various harmful stimuli. However, in several chronic debilitating disorders, such as chronic kidney disease, inflammation becomes maladaptive, uncontrolled and persistent. Systemic persistent inflammation has, for almost 20 years, been recognized as a major contributor to the uraemic phenotype (such as cardiovascular disease, protein energy wasting, depression, osteoporosis and frailty), and a predictor of cardiovascular and total mortality. Since inflammation is mechanistically related to several ageing processes (inflammageing), it may be a major driver of a progeric phenotype in the uraemic milieu. Inflammation is likely the consequence of a multifactorial aetiology and interacts with a number of factors that emerge when uraemic toxins accumulate. Beside interventions aiming to decrease the production of inflammatory molecules in the uraemic milieu, novel strategies to increase the removal of large middle molecules, such as expanded haemodialysis, may be an opportunity to decrease the inflammatory allostatic load associated with retention of middle molecular weight uraemic toxins.

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“…Medium cut-off (MCO) dialyzers can remove middle and large uremic toxins close to the molecular size of albumin (68,000 Da) [11][12][13][14]. MCO dialyzers have been introduced to the dialysis practice as they can perform hemodialysis as efficient as online HDF.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study

et al. 2020

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Introduction: Removal of uremic toxins is a main objective of hemodialysis; however, whether high-flux and medium cutoff (MCO) membranes differ as regards removal of middle and large uremic toxins is not clear. Objective: To compare medium cutoff and high-flux dialyzers as regards their intra-and interdialysis effect on circulating levels of middle and large uremic toxins and serum albumin. Methods: Fiftytwo patients were randomized to have hemodialysis with either 3 months of high-flux dialyzer followed by 3 months of MCO or vice versa. Blood samples were taken before and after dialysis at the first and last sessions of each dialyzer for analyses of middle and large uremic toxins including inflammatory mediators and vascular endothelial growth factor (VEGF), and serum albumin. Results: Reduction rates were higher, and postdialysis levels of β-2 microglobulin, free kap-pa and lambda light chains, and myoglobulin were lower at the first and last sessions with MCO dialyzers compared to high-flux dialyzers (p < 0.05 for all). Last session predialysis levels of β-2 microglobulin, free kappa light chain, and free lambda light chain were lower than first session predialysis levels in MCO dialyzers as compared to high-flux dialyzers (p < 0.05 for all). Last session levels of interleukin-6, interleukin-10, interleukin-17, and interferon-gamma did not differ between dialyzers (p > 0.05 for all). VEGF level was lower in the MCO group compared to the high-flux group (p = 0.043). Last session level of serum albumin with MCO dialyzers was lower than that with high-flux dialyzers (3.62 [3.45-3.88] vs. 3.78 [3.58-4.02] g/L) (p = 0.04) and 6.7% lower (p < 0.001) than at the first session of MCO dialyzers. Conclusion: The decline in circulating levels of several middle and large uremic toxins including VEGF following hemodialysis was more pronounced when using MCO membranes as compared to high-flux membranes while their effect on inflammatory molecules was similar.

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Effects of Hemodialysis Therapy Using Dialyzers with Medium Cut-Off Membranes on Middle Molecules

Cited by 24 publications

References 6 publications

Gut Microbiota and Cardiovascular Uremic Toxicities

Gut Microbiota and Cardiovascular Uremic Toxicities

Chronic inflammation in end-stage renal disease and dialysis

Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study

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