Efficacy of medium cut‐off dialyzers and comparison with high‐flux dialyzers in patients on maintenance hemodialysis: A systematic review and meta‐analysis

Abstract

Medium cut-off (MCO) dialyzers were designed to provide better clearance of uremic toxins. We conducted a meta-analysis comparing MCO with high-flux (HF) dialyzers for the effect on uremic toxins in maintenance hemodialysis (HD) patients. Five databases were systematically searched for relevant studies and nine studies were identified finally. Reduction ratio (RR) of urea, urea, creatinine, β2-macroglobulin (β2-MG), kappa free light chain (κFLC), and lambda FLC (λFLC) levels were not significantly different between MCO and HF dialyzers. But RR of β2-MG, κFLC, and λFLC were greater for MCO than HF dialyzers. MCO dialyzers could better reduce tumor necrosis factor-α (TNF-α) levels. Subgroup analysis stratified by study design indicated that in randomized controlled trial (RCT) studies, albumin levels was lower in MCO than HF dialyzers group, but the two dialyzers treatments were equivalent in non-RCT subgroup. Compared with HF dialyzers, MCO dialyzers provided higher middlemolecules uremic toxins clearance and obviously reduced TNF-α levels.

Theranova versus FX80: The impact on anemia management in hemodialysis

“…10 A meta-analysis involving 177 patients has reported a decrease in TNF-α levels with Theranova in comparison to high-flux dialyzers. 15 An observational study involving 81 patients who underwent at least 1 year of high-flux hemodialysis followed by a switch to Theranova for at least 1 year, reported slightly lower doses of ESA and intravenous iron for similar hemoglobin levels. 16 A 3-year follow-up observational study involving 42 patients, reported no difference in darbepoetin alfa use between MCO and high-flux dialysis.…”

Effects of a medium cut‐off dialyzer on inflammation and cardiac and vascular function in hemodialysis patients with heart failure

“…However, this method is expensive, requires ultrapure dialysate, and causes significant albumin loss. 22 On the other hand, MCO membranes, a novel class of membranes with a more extensive distribution of larger sizes and a higher number of pores, provide higher permeability and increased convective transport. Thus, HDx could provide clearance of higher molecular weight uremic toxins up to 45 kDa, associated with immune dysfunction inflammation and adverse outcomes in dialysis patients.…”

Expanded Hemodialysis Therapy: From the Rational to the Delivery

“…In addition, several randomized controlled studies suggest that HF dialyzers are more effective in removing B2M than low flux membranes. Regarding HDx, studies have shown that HDx with MCO membranes results in a greater reduction ratio of a broad range of molecules, including B2M compared to HF membranes [8,[20][21][22][23]. There are several factors that can affect the clearance of B2M [8], in the study conducted by Lim [24], the reduction ratio achieved was slightly lower, and the B2M clearance was not significantly different, which was probably due to a low blood flow rate.…”

“…According to the molecular weight of these uremic toxins, they are divided into six classes, including small water-soluble molecules (<500 Da), protein-bound uremic toxins (PBUTs; mostly <500 Da), small-middle molecules (0.5-15 kDa), mediummiddle molecules (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), large-middle molecules , and large molecules (>58 kDa) [5]. Complications, such as anemia, neuropathies, osteodystrophy, dialysis-related amyloidosis, accelerated atherosclerosis, and cardiovascular complications, have been correlated with uremic toxins in the molecular range of 5-50 kDa [6].…”