Randomised trial on clinical performances and biocompatibility of four high-flux hemodialyzers in two mode treatments: hemodialysis vs post dilution hemodiafiltration

Abstract

This prospective multicenter randomized comparative cross-over trial aimed at evaluating the influence of hemodialysis vs post-dilution hemodiafiltration with high-flux dialyzers in solute clearance and biocompatibility profile. 32 patients were sequentially dialyzed with Leoceed-21HX, Polypure-22S+, Rexsys-27H and VIE-21A. Primary outcome was β2-microglobulin removal. Secondary outcomes were (i) extraction of other uremic solutes (ii) parameters of inflammation and nutrition and (iii) comparative quantification of perdialytic albumin losses (using total ‘TDC’ vs partial ‘PDC’ collection of dialysate). Significant increases in removal rates of β2-microglobulin (84.7 ± 0.8 vs 71.6 ± 0.8 mg/L), myoglobin (65.9 ± 1.3 vs 38.6 ± 1.3 µg/L), free immunoglobulin light chains Kappa (74.9 ± 0.8 vs 55.6 ± 0.8 mg/L), β-trace protein (54.8 ± 1.3 vs 26.8 ± 1.4 mg/L) and orosomucoid (11.0 ± 1.1 vs 6.0 ± 1.1 g/L) but not myostatin (14.8 ± 1.5 vs 13.0 ± 1.5 ng/mL) were observed in HDF compared to HD when pooling all dialyzers. Rexsys and VIE-A use in both HD and HDF subgroups was associated to a better removal of middle/large-size molecules compared to Leoceed and Polypure, except β2-microglobulin for Rexsys. Inflammatory parameters were unchanged between dialyzers without any interaction with dialysis modality. Mean dialysate albumin loss was comparable between TDC and PDC (1.855 vs 1.826 g/session for TDC and PDC respectively). In addition, a significant difference in albumin loss was observed between dialyzers with the highest value (4.5 g/session) observed using Rexsys. Use of all dialyzers was associated with good removals of the large spectrum of uremic toxins tested and good biocompatibility profiles, with an additional gain in removal performances with HDF. Larger surface area, thinner wall and resultant very high ultrafiltration coefficient of Rexsys should be taken into account in its clear performance advantages.

Clinical performance, intermediate and long‐term outcomes of high‐volume hemodiafiltration in patients with kidney failure

“…Many studies on high-volume OL-HDF have demonstrated a superior removal of higher molecular weight substances-such as b2MG, myoglobin, free immunoglobulin light chains Kappa, β-trace protein, orosomucoid, indoxyl-sulfate, and p-cresyl-sulfate-as compared to HD. 7,8 Higher fluid substitution rates are associated with higher b2MG clearances post-HDF therapies. 9 The maximum benefit of OL-HDF on middle molecule removal may be achieved with 24 L substitution volume per 4-h treatment.…”

“…Where some studies suggest no differences in HRQoL scores between HDF and HD patients, [7][8][9][10]46 conversely, others have demonstrated a beneficial effect of HDF on HRQOL, including social, physical, and professional domains in association with fewer episodes of hypotension, cramps, itching, fatigue, joint pain, and stiffness. 8,[12][13][14] However, this evidence is limited in terms of sample size and follow-up.…”

“…Mass removal is generally a better indicator of solute removal than predialysis or postdialysis blood concentrations. Many studies on high‐volume OL‐HDF have demonstrated a superior removal of higher molecular weight substances—such as b2MG, myoglobin, free immunoglobulin light chains Kappa, β‐trace protein, orosomucoid, indoxyl‐sulfate, and p‐cresyl‐sulfate—as compared to HD 7,8 . Higher fluid substitution rates are associated with higher b2MG clearances in post‐HDF therapies 9 .…”

High-Flux dialyzer 2.6 m2 is promising for free light chains removal in high-flux hemodialysis and in hemodiafiltration

“…-Calculation of FLC post-dialysis concentration corrected for net ultrafiltration with the following equation: 4 ,13 Fpost.c = -Cumulative albumin loss was measured by the following equations: 12,14 Cumulative dialysate Albumin (gm) = Albumin ½ hr + Albumin 1 st hr +Albumin 3 rd hr + Albumin 4 th hr -Albumin lost over first half or 1 st hour was measured by equation "A".…”

Why and how high volume hemodiafiltration may reduce cardiovascular mortality in stage 5 chronic kidney disease dialysis patients? A comprehensive literature review on mechanisms involved

“…11,12 Regular use of ultrapure dialysis fluid, as required for online HDF contributes to improved hemocompatibility of the dialysis system and reduces inflammation reactions. 13,14 Advances in technology, have resulted in online HDF becoming as simple, safe and costeffective as regular hemodialysis. [15][16][17] Successful clinical implementation of online HDF took less than 3 days in naïve centers, as recently shown in a large prospective study.…”