Medium cut-off dialyzer for middle molecular uremic toxins in AKI and chronic dialysis

Abstract

Uremic toxins accumulate in patients affected by renal failure and can deposit in different organs, including the kidneys and heart. Given their physicochemical characteristics, uremic toxins can contribute to organ dysfunction due to several pathobiological actions at cellular and molecular levels. Several uremic compounds have been described in serum and plasma from patients with acute kidney injury (AKI) and kidney failure; they are usually classified based on their molecular size and protein-binding properties. In this scenario, new dialytic approaches have been proposed in the last few years with the aim of improving uremic toxin removal. Recent studies which focused on the use of medium cut-off membranes in patients on chronic hemodialysis have shown a discrete ability to remove β2-microglobulin and other middle molecules, such as kappa and lambda free light chains, complement factor D and α1-microglobulin. However, current evidence is mainly based on the impact on short-term outcomes and, consequently, longer observational studies are necessary to confirm the efficacy and safety of the medium cut-off dialyzer. Here we present the state-of-the-art on the clinical application of medium cut-off membranes in AKI and chronic dialysis patients. Graphical abstract

A chronic intermittent haemodialysis pig model for functional evaluation of dialysis membranes

“…22 In addition, the clinical application of medium cut-off membranes has attracting attention in acute kidney injury and chronic dialysis patients. 23 The results of the present study suggest that a porcine in vivo haemodialysis model will be suitable for investigating and validating the properties of dialysis membranes not only in HD and HDF, but also in CVVH.…”

Theranova versus FX80: The impact on anemia management in hemodialysis

“…[6][7][8] The efficacy of Medium Cut-Off (MCO) dialyzers, like Theranova, in eliminating middle-sized molecules, including MUTs, has been substantiated in prior research. 9 Additionally, there is supporting evidence indicating potential enhancements in anemia management through the reduction of resistance to erythropoiesis-stimulating agents (ESAs). 10 The improvement of erythropoietin stimulating agent (ESA) responsiveness or the potential elimination of the need for ESA therapy can be a significant advancement in managing anemia in hemodialysis patients.…”