Medium Cut-Off Dialysis Membranes: Can They Have Impact on Outcome of COVID-19 Hemodialysis Patients?

Yalın, Serkan Feyyaz; Altiparmak, Mehmet Rıza; Dinçer, Mevlüt Tamer; Yadigar, Serap; Murt, Ahmet; Parmaksız, Ergün; Ronco, Claudio

doi:10.1159/000513621

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…However, this study was focused on inflammatory mediator changes: pre-and post-HD IL-6 blood levels were measured only in the first session (HD with MCO) at diagnosis and no significant differences were detected [17]. Yalin et al [39] did not find any difference in mortality in a retrospective study that examined 60 CHD patients affected by SARS-CoV-2 treated with MCO or low-flux membranes. Tarakcioǧlu et al [40] evaluated cytokines removal in 21 stable CHD patients treated with low-flux HD and did not find any difference as to IL-1 beta, IL-6, TNF-alpha, and sIL-2R concentrations between pre-and post-HD specimens.…”

Section: Discussion/conclusionmentioning

confidence: 98%

Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers?

et al. 2022

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Introduction: High-flux hemodialysis membranes may modulate the cytokine storm of SARS-CoV-2, but their impact on chronic hemodialysis (CHD) patients is unknown. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers and clinical outcomes in CHD patients with SARS-CoV-2. Methods: A prospective, observational study on CHD patients with SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021. Pre- and postdialysis C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were determined at each session. Patients who underwent on-line hemodiafiltration (OLHDF) with a PMMA dialyzer were compared with those treated with OLHDF with a ATA dialyzer. The primary endpoint was the differences in the reduction ratio per session (RR) of CRP, PCT, IL-6, and IL-6 RR >25%. Results: We consecutively enrolled 74 CHD patients with COVID-19, 48 were treated with ATA membrane, and 26 with PMMA. Median IL-6 RR was higher in the ATA group compared to PMMA (17.08%, IQR −9.0 to 40.0 vs. 2.95%, IQR −34.63 to 27.32). Median CRP RR was 7.77% (IQR 2.47–13.77) in the ATA group versus 4.8% (IQR −2.65 to 11.38) in the PMMA group (p = 0.0017). Median PCT-RR% was 77.38% (IQR 70.92–82.97) in ATA group versus 54.59% (IQR 42.62–63.16) in the PMMA group (p < 0.0001). A multiple logistic regression analysis with IL-6 RR >25% as the outcome including the membrane employed, pre-dialysis IL-6, CRP, PCT, and ferritin showed that ATA led to a higher probability to reach the outcome (OR 1.891, 95% CI 1.273–2.840, p = 0.0018) while higher CRP favors the risk of lower IL-6 RR values (OR 0.910, 95% CI 0.868–0.949, p ≤ 0.0001). Conclusions: In SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile, regarding IL-6 RR, compared to PMMA.

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Section: Discussion/conclusionmentioning

confidence: 98%

Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers?

et al. 2022

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“…Medium cut-off membranes are quite promising and their benefits in COVID-19 patients have been reported before. 12 , 13 COVID severity was the most important factor for mortality in our multivariate model whereas inflammatory markers and co-morbidities were not found to be significant. This might be because, high levels of inflammatory markers are related to COVID severity and hemodialysis patients already have a high burden of co-morbidities.…”

Section: Discussionmentioning

confidence: 55%

Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection

et al. 2021

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Background: While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. Methods: One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. Results: COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels ( p = 0.02) and longer hospital stay ( p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05–10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53–41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival ( p = 0.000) Conclusions: AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.

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“…A study by Esposito et al [15] compared the MCO dialyzer with a protein-leaking membrane dialyzer in 29 HD patients with COVID-19 and found that IL-6 RR was 10% with MCO, which is similar to the IL-6 RR seen in our study. Yalin et al [14] have reported data from 60 COVID-19 HD patients from a hospital that uses LF dialyzer and from another hospital that uses the MCO dialyzer and show that mortality was 16.6% (4/24 patients) in the MCO group and 26.4% (10/36 patients) in the LF group. Death and need for ICU were similar in both hospitals, even though MCO dialyzer patients had higher ferritin and CRP.…”

Section: Discussionmentioning

confidence: 99%

“…The new dialyzer membrane, namely, the medium cut-off (MCO) membrane, can remove large middle molecules and inflammatory cytokines in chronic HD patients [9][10][11][12][13], and both dialysis and cytokine removal can be simultaneously performed in the same session. However, as very few studies have evaluated the effects of dialyzer membrane types in chronic HD patients with COVID-19, the results remain inconclusive [14,15]. Hence, this study aimed to compare MCO and low-flux (LF) membrane dialyzers in terms of IL-6 reduction, change in inflammatory state, intradialytic complications, and mortality in chronic HD patients diagnosed with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Medium Cut-Off versus Low-Flux Dialyzers in Hemodialysis Patients with COVID-19: Clinical Outcomes and Reduction in Interleukin-6

Pongsittisak,

Satpanich,

Jaturapisanukul

et al. 2023

Blood Purif

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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused extensive morbidity and mortality worldwide. Hemodialysis (HD) patients are both vulnerable to COVID-19 infection and tend to suffer greater disease severity and mortality. This retrospective study aimed to compare medium cut-off (MCO) and low-flux (LF) membrane dialyzers in terms of interleukin-6 (IL-6) reduction, change in inflammatory state, intradialytic complications, and mortality in chronic HD patients with COVID-19. Method: HD patients with a confirmed COVID-19 infection were admitted to the hospital for 10–14 days and underwent HD at the COVID-HD unit. Choice of dialyzer membrane used (MCO vs. LF) depended on the primary nephrologist(s). We collected data on demographics, baseline characteristics, laboratory results, diagnosis, treatments, HD prescription, hemodynamic status during HD, and mortality at 14 and 28 days after. Results: IL-6 reduction ratio (RR) in the MCO group was 9.7 (interquartile range, 71.1) percent, which was significantly higher than that of the LF group (RR, −45.7 [interquartile range, 70.2] percent). The incidence rate of intradialytic hypotension in the MCO group was 3.846 events per 100 dialysis hours (95% confidence interval [CI], 1.954–6.856), which was significantly lower than that of the LF group (9.057; 95% CI, 5.592–13.170). Overall, mortality was not significantly different between the two groups. Conclusion: The MCO membrane was more effective in removing IL-6 and was better tolerated than the LF membrane. Large, randomized controlled trials are required to confirm the relative benefits of the MCO membrane, especially mortality. However, due to the COVID-19 pandemic, our results suggest that the MCO membrane may be beneficial in chronic HD patients with COVID-19.

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Medium Cut-Off Dialysis Membranes: Can They Have Impact on Outcome of COVID-19 Hemodialysis Patients?

Cited by 6 publications

References 19 publications

Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers?

Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers?

Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection

Medium Cut-Off versus Low-Flux Dialyzers in Hemodialysis Patients with COVID-19: Clinical Outcomes and Reduction in Interleukin-6

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