Medium cut‐off dialyzers in a large population of hemodialysis patients in Colombia: COREXH registry

Abstract

Expanded hemodialysis (HDx) provides increased clearance of conventional and large middle molecules through innovative medium cutoff (MCO) membranes. However, there is a paucity of real‐world data regarding the benefits and safety of HDx. This large observational study evaluated outcomes among patients in Colombia undergoing HDx at a extended dialysis clinical services provider. This was a prospective single cohort study of prevalent patients who were treated with HDx; baseline information was collected from the most recent data before patients were started on HDx. Patients were followed prospectively for 1 year for changes in serum albumin and other laboratory parameters compared with the baseline. Survival, hospitalization and safety were assessed from the start of HDx. A total of 1000 patients were invited to enroll; 992 patients met the inclusion criteria for data analysis and 638 patients completed the year of follow‐up. Seventy‐four (8%) patients died during 866 patient‐years (PY) of follow‐up; the mortality rate was 8.54 deaths/100 PY (95% confidence interval [CI], 6.8‐10.7). There were 673 hospitalization events with a rate of 0.79 events/PY (95% CI, 0.73‐0.85) with 6.91 hospital days/PY (95% CI, 6.74‐7.09). The observed variability from baseline and maximum average change in mean serum albumin levels were −1.8% and −3.5%, respectively. No adverse events were related to the MCO membrane. HDx using an MCO membrane maintains stable serum albumin levels and is safe in terms of nonoccurrence of dialyzer related adverse events.

An initial evaluation of expanded hemodialysis on hospitalizations, drug utilization, costs, and patient utility in Colombia

“…One aspect to consider is that due to the type of design, we evaluated a stable population during the 2 years of follow‐up (before and after the dialyzer's switch), which means that it does not necessarily fully represent the population on dialysis. However, this caveat could be balanced by recent evidence showing the efficacy and safety of HDx in a much larger population of patients in routine HD practice [ 24 ].…”

“…Abbreviations: CKD, chronic kidney disease; HD HF, high flux hemodialysis; IQR, interquartile range.4 | DISCUSSIONRecently, expanded hemodialysis (HDx) by medium cutoff dialyzers has shown efficacy and safety outcomes[11,[21][22][23][24]; however, few studies report effectiveness outcomes or economic analyzes. This study provides a first look at the potential impact of using HDx relative to HD HF in patients in Colombia.…”

Slipping Through the Pores: Hypoalbuminemia and Albumin Loss During Hemodialysis

“… 66 Recently published data from the Expanded Hemodialysis Registry Protocol in Colombia (COREXH) Registry from nearly 1000 HD patients also demonstrated statistically significant reductions in serum albumin with MCO membrane use. 67 Maximal reductions in albumin levels were evident at month 3. In the small study (N = 6) mentioned previously, Ronco and colleagues did not note changes in serum albumin levels after 6 months of HD with an MCO dialyzer (baseline albumin ~3.5 mg/dl).…”

Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode

“…15,16 A medium cut-off (MCO) membrane was recently introduced, allowing for expanded hemodialysis (HDx) to achieve more effective clearance of large MMs, even when compared to HDF. 17,18 Safe application of the HDx therapy was confirmed in controlled studies, [19][20][21][22] while long-term outcome data for HDx in comparison to HD or HDF are still scarce. A large one-year prospective observational study indicated that peoples' quality of life was improved with HDx therapy, 23 but further studies are needed to assess the impact of enhanced dialytic removal of large MMs on the dialysis-related symptom burden.…”