High‐permeability alternatives to current dialyzers performing both high‐flux hemodialysis and postdilution online hemodiafiltration

Maduell, Francisco; Rodas, Lida; Broseta, José Jesús; Gómez, Miguel; Xipell, Marc; Molina, Ángel; Guillén, Elena; Arias‐Guillén, Marta; Fontseré, Néstor; Vera, Manel; Rico, Nayra

doi:10.1111/aor.13480

Cited by 38 publications

(54 citation statements)

References 29 publications

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“…Kirsch et al 7 Garcia-Prieto et al 8 Maduell et al 9 The present study (Table 5). These studies were performed for quite short-term treatment; therefore, the real effectiveness of MCO-HD in removals of middle-molecule uremic toxins is still not firmly established.…”

Section: Studiessupporting

confidence: 50%

“…With limitations of high-volume postdilution ol-HDF, HD with the new type of dialyzer, which has larger pore size than standard high-flux dialyzer, might provide better removal of protein-bound and middle-molecule uremic toxins. [7][8][9] Medium cut-off (MCO) from Europe and super high-flux (SHF) such as PES 17D alpha (PES) from Japan are two new large pore size dialyzers. Very few studies regarding MCO-HD were performed as a shortterm study and did not examine the effectiveness in removals of protein-bound uremic toxins.…”

Section: Introductionmentioning

confidence: 99%

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Super high‐flux hemodialysis provides comparable effectiveness with high‐volume postdilution online hemodiafiltration in removing protein‐bound and middle‐molecule uremic toxins: A prospective cross‐over randomized controlled trial

et al. 2020

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Although high‐volume postdilution online hemodiafiltration (ol‐HDF) is superior to high‐flux HD in removing all kinds of uremic toxins and improving survival, this treatment is not available in most HD centers. The present study was conducted to compare the effectiveness in removals of protein‐bound (indoxyl sulfate [IS]), middle‐molecule [beta‐2 microglobulin (B2M) and alpha‐1 microglobulin (A1MG)], and small‐molecule uremic toxins between super high‐flux HD (SHF‐HD), HD with a novel SHF dialyzer and high‐volume postdilution ol‐HDF in a noninferiority fashion. Fifteen prevalent HD patients were randomly allocated into two sequences of 12‐week treatment periods of SHF‐HD treatment and later high‐volume postdilution ol‐HDF period or vice versa. Each treatment period was divided by a wash‐out phase of 4‐week high‐flux HD. Twelve of 15 patients could complete the study. When compared with high‐volume postdilution ol‐HDF (convective volume of 24.4 ± 3.52 L), SHF‐HD provided comparable reduction ratio values of IS, B2M, and A1MG with mean difference of 5.87 (95% confidence interval [CI] ‐1.63, 13.37), 1.98 (95% CI,‐0.21, 4.18), and 22.96 (95% CI, ‐1.91, 47.83), respectively. The spKt/Vurea was not different. The predialysis levels of all uremic toxins at baseline and after 12‐week treatment did not differ between both groups. Although albumin loss in dialysate in SHF‐HD was greater than high‐volume postdilution ol‐HDF, the serum albumin levels after 12‐week SHF‐HD treatment were significantly higher than baseline. In conclusion, SHF‐HD provides noninferior effectiveness to high‐volume postdilution ol‐HDF in removing various uremic toxins with significantly increased serum albumin levels despite higher albumin loss. SHF‐HD might be an effectively alternative treatment when high‐volume postdilution ol‐HDF is not available.

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Section: Studiessupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Super high‐flux hemodialysis provides comparable effectiveness with high‐volume postdilution online hemodiafiltration in removing protein‐bound and middle‐molecule uremic toxins: A prospective cross‐over randomized controlled trial

et al. 2020

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“…On the one hand, they can be explained by the dialyzer used in the comparison with the HDF technique, as Kirsch et al 3 and Garcia-Prieto et al 4 used a Helixone membrane while Reque et al 13 and Belmouaz et al 14 used polyamide membranes. Maduell et al 5,15 showed small differences in removal performance when comparing eight different high-flux dialyzers in post-HDF. On the other hand, the way in which HDF is carried out is extremely important because parameters such as Qb, replacement volume, convective volume, Q uf , or FF can potentially influence the removal capacity of the technique.…”

Section: T a B L E 3 (Continued)mentioning

confidence: 99%

“…Belmouaz et al 14 obtained similar results. However, Garcia-Prieto et al 4 and Maduell et al 5,[15][16] reported that β 2 -microglobulin, myoglobin, α 1 -microglobulin, prolactin, and free immunoglobulin light chain reduction ratios were higher with HDF.…”

Section: Introductionmentioning

confidence: 98%

Determining factors for hemodiafiltration to equal or exceed the performance of expanded hemodialysis

et al. 2020

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The aim of the study was to compare expanded hemodialysis (HDx) with hemodiafiltration (HDF) at different infusion flows to identify the main determinants, namely blood flow (Qb), replacement volume, infusion flow (Qi), ultrafiltration flow (Quf), filtration fraction (FF), and the point at which the effectiveness of HDF equals or exceeds that of HDx. We conducted a prospective, single‐center study in 12 patients. Each patient underwent 12 dialysis sessions: six sessions with Qb 350 and six with Qb 400 mL/min; with each Qb, one session was with HDx and five sessions were with FX80 (one in HD, and four with Qi 50, 75, 90/100 mL/min or autosubstitution in postdilution HDF). The reduction ratios (RR) of urea, creatinine, ß2‐microglobulin, myoglobin, prolactin, α1‐microglobulin, α1‐acid glycoprotein, and albumin were compared intraindividually and the global removal score (GRS) was calculated. The mean replacement volume with Qb 350 mL/min was 13.77 ± 0.92 L with Qi 50 mL/min, 20.75 ± 1.17 L with Qi 75, 23.83 ± 1.92 L with Qi 90, and 27.51 ± 2.77 L with autosubstitution. Similar results were obtained with Qb 400 mL/min, and the results were only slightly higher with Qi 100 mL/min or in autosubstitution. The GRS was positively correlated with replacement volume with Qb 350 (R2 = 0.583) and with Qb 400 (R2 = 0.584); with Quf with Qb 350 (R2 = 0.556) and with Qb 400 (R2 = 0.604); and also with FF with Qb 350 (R2 = 0.556) and with Qb 400 mL/min (R2 = 0.603). The minimum convective volume in HDF from which it is possible to overcome the efficacy of HDx was 19.2 L with Qb 350 and 17.6 L with Qb 400 mL/min. The cut‐off point of Quf at which HDF exceeded the effectiveness of HDx was 80.6 mL/min with Qb 350 and 74.1 mL/min with Qb 400 mL/min. The cut‐off point at which FF in HDF exceeded the effectiveness of the HDx was 23.0% with Qb 350 and 18.6% with Qb 400 mL/min. In conclusion, this study confirms the superiority of postdilution HDF over HDx when replacement volume, convective volume, Quf, or FF exceeds certain values. Increasing the Qb in postdilution HDF manages to increase the convective dose and more easily overcome the HDx.

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“…Francisco Maduell et al of the Hospital Clínic Barcelona, Barcelona, Spain compared the safety and efficacy of a currently used dialyzer in hemodialysis (HD) and online hemodiafiltration (OL‐HDF) with those of several other high permeability dialyzers which should only be used in HD. A prospective, single‐center study was carried out in 21 patients.…”

Section: Renal Support and Dialysismentioning

confidence: 99%

Artificial Organs 2019: A year in review

Malchesky¹

2020

Artificial Organs

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In this Editor’s Review, articles published in 2019 are organized by category and summarized. These provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders “to foster communications in the field of artificial organs on an international level.” Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer‐reviewed Special Issues this year included contributions from the 14th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr Akif Undar, and the 26th Congress of the International Society for Mechanical Circulatory Support edited by Dr Minoru Ono and Dr Francesco Moscato. Additionally, important editorials highlighted the need for sustainability in hemodialysis, challenges and opportunities in mechanical circulatory support, progress in artificial pancreas development, historical perspectives on ventilators and dialysis, tissue engineering for cardiac support, and regional updates from India and China. Our Pioneer Series continues to highlight the many researchers who created this field of study. This year we debuted a new series entitled “Recent Progress in Artificial Organs” prepared by Vakhtang Tchantchaleishvili and Elizabeth Maynes of Thomas Jefferson University, Philadelphia, PA, USA. This series highlights recent advances and new developments in the field. We take this time also to express our gratitude to our authors for contributing their work to this journal. We offer our very special thanks to our reviewers who give so generously of their time and expertise to review, critique, and especially provide meaningful suggestions to the author’s work. Without our dedicated expert reviewers, the quality expected from such a journal would not be possible. We also express our special thanks to our Publisher, John Wiley & Sons, for their expert attention and support in the production Artificial Organs. We look forward to reporting further advances in the coming years.

show abstract

High‐permeability alternatives to current dialyzers performing both high‐flux hemodialysis and postdilution online hemodiafiltration

Cited by 38 publications

References 29 publications

Super high‐flux hemodialysis provides comparable effectiveness with high‐volume postdilution online hemodiafiltration in removing protein‐bound and middle‐molecule uremic toxins: A prospective cross‐over randomized controlled trial

Super high‐flux hemodialysis provides comparable effectiveness with high‐volume postdilution online hemodiafiltration in removing protein‐bound and middle‐molecule uremic toxins: A prospective cross‐over randomized controlled trial

Determining factors for hemodiafiltration to equal or exceed the performance of expanded hemodialysis

Artificial Organs 2019: A year in review

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