The Effect of On-line High-flux Hemofiltration Versus Low-flux Hemodialysis on Mortality in Chronic Kidney Failure: A Small Randomized Controlled Trial

Santoro, Antonio; Mancini, Elena; Bolzani, Roberto; Boggi, R.; Cagnoli, L; Francioso, A.; Fusaroli, M; Piazza, V.; Rapanà, Renato; Strippoli, Giovanni F.M.

doi:10.1053/j.ajkd.2008.05.011

Cited by 76 publications

(53 citation statements)

References 24 publications

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“…It is possible that longer duration of the use of HCO membranes would reduce or limit the increase in pre-dialysis ␤ 2M concentrations in the longterm [5][6][7] . A recent randomized controlled trial by the Membrane Permeability Outcome Study Group assigned patients with either low ( ^ 40 mg/l) or normal ( 1 40 mg/l) serum albumin, who had commenced on haemodialysis within 30 days, to either low-flux or HF membranes for haemodialysis, followed them for more than 3 years, and found that HF dialysis resulted in a significantly lower accumulation of ␤ 2M (by 4.4 8 7.8 mg/l) than low-flux dialysis (by 8.0 8 12.3 mg/l) [19] .…”

Section: Discussionmentioning

confidence: 99%

“…Different strategies reported to increase ␤ 2M clearance include on-line haemofiltration [7] , haemodiafiltration (post-dilution in particular) [8] , absorbent columns [9] , and increased frequency [10] or prolonged duration of dialysis [11] . Another approach is conventional haemodialysis using dialysis membranes with larger pore size to enhance removal whilst aiming to limit albumin loss.…”

Section: Introductionmentioning

confidence: 99%

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A Pilot, Randomized, Double-Blind, Cross-Over Study of High Cut-Off versus High-Flux Dialysis Membranes

et al. 2009

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Background: High cut-off (HCO) membranes may increase β₂-microglobulin (β2M) removal compared to standard high-flux membranes.Methods:Eight stable haemodialysis patients were enrolled in a prospective, randomized, double-blind, cross-over study and treated with HCO and high-flux membranes for 2 weeks each, between a 1-week washout period. Primary end point was serum β2M removal. Secondary end points included serum albumin concentrations, albumin and small solute clearances. Results: HCO membranes achieved significantly lower median post-dialysis β2M concentration (10.8 vs. 14.2 mg/l; p = 0.003) and greater β2M reduction ratio (62.3 vs. 51.0%; p < 0.002). Serum albumin decreased with HCO membranes (from 36 to 29.5 g/l; p = 0.018) but increased to 33.5 g/l after the washout period. Albumin clearance was significantly greater with HCO membranes (2.2 vs. 0.06 ml/min; p = 0.004). Urea reduction ratio was significantly lower with HCO membranes (64.8 vs. 71.5%; p < 0.001). Conclusion: β2M removal was superior with HCO membranes. Reduction in serum albumin and lower small solute clearance require further investigations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Pilot, Randomized, Double-Blind, Cross-Over Study of High Cut-Off versus High-Flux Dialysis Membranes

et al. 2009

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“…λ-FLC are present in the plasma of normal subjects in dimeric forms of 50 kDa. Several studies have shown that on-line hemodiafiltration (ol-HDF) with high substitution volume increases middle-sized molecule removal compared with conventional HD [14,15,16,17,18]. In an attempt to remove monoclonal FLC, plasma exchange, high-flux HD, and ol-HDF were used in patients suffering from multiple myeloma [19,20,21,22].…”

Section: Introductionmentioning

confidence: 99%

Comparison between On-Line High-Efficiency Hemodiafiltration and Conventional High-Flux Hemodialysis for Polyclonal Free Light Chain Removal

Lamy

Henri²,

Lobbedez³

et al. 2014

Blood Purif

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Background: Polyclonal free light chains (FLC) are considered as middle molecular weight uremic toxins in chronic kidney disease. In this study, we investigate polyclonal FLC removal by comparing conventional high-flux hemodialysis (HD) and online high-efficiency hemodiafiltration (ol-HDF) in end-stage renal disease patients. Methods: We analyzed 31 chronic dialysis patients who were treated by HD then by postdilution ol-HDF during a prospective study. All patients were anuric and without monoclonal gammopathy. Serum pre- and postdialysis FLC were collected during 4 sessions: 1 HD session and 3 ol-HDF sessions. We calculated the reduction ratio using kinetic modeling. Results: The κ reduction ratio was higher with ol-HDF than with HD (66 ± 14 vs. 52 ± 13%, p < 0.001). However, the λ reduction ratio was not significantly higher with ol-HDF (37 ± 20 vs. 37 ± 15%, p = 0.67). Furthermore, predialysis κ- and λ-FLC increased with ol-HDF compared with HD (κ 155 ± 82 vs. 87 ± 47 mg/l, p < 0.05; λ 101 ± 46 vs. 72 ± 41 mg/l, p < 0.05). Postdialysis FLC levels were raised only for λ-FLC with ol-HDF (74 ± 39 vs. 53 ± 31 mg/l, p < 0.05) and were not significantly different for κ. Conclusions: This study shows that κ-FLC removal is better in ol-HDF compared with HD, whereas there is no difference in λ-FLC removal. Surprisingly, predialysis κ and λ levels are both increased in ol-HDF, which is disturbing since polyclonal excess of λ-FLC is associated with mortality in chronic kidney disease.

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“…One small trial, comparing on-line hemofiltration to low-flux dialysis illustrated a survival superiority for hemofiltration [73]. However, only 2 groups of 32 subjects were randomized into this study, of which only 11 subjects per group finished the 3-year follow-up period.…”

Section: Interventional Outcome Studies Based On Removalmentioning

confidence: 99%

Advantages of New Hemodialysis Membranes and Equipment

Vanholder

Glorieux

Biesen³

2009

Nephron Clin Pract

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Chronic kidney disease is characterized by the progressive retention of a number of compounds, several of which have the potential to cause cardiovascular damage. Many of these are difficult to remove by standard dialysis strategies. Removal of the larger middle molecules (mostly larger peptidic compounds) can be obtained by increasing dialyzer pore size and/or by applying convective strategies. For protein-bound solutes, convection (essentially hemodiafiltration) positively affects removal. The HEMO study demonstrated outcome superiority for the large-pore high-flux hemodialysis membranes in a number of subgroup analyses. Likewise, the Membrane Permeability Outcome study showed outcome superiority for high flux in patients with serum albumin <4 g/dl, the group for which the study had originally been designed. Apart from a small controlled trial, data suggesting superiority for convective strategies are all observational.

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The Effect of On-line High-flux Hemofiltration Versus Low-flux Hemodialysis on Mortality in Chronic Kidney Failure: A Small Randomized Controlled Trial

Cited by 76 publications

References 24 publications

A Pilot, Randomized, Double-Blind, Cross-Over Study of High Cut-Off versus High-Flux Dialysis Membranes

A Pilot, Randomized, Double-Blind, Cross-Over Study of High Cut-Off versus High-Flux Dialysis Membranes

Comparison between On-Line High-Efficiency Hemodiafiltration and Conventional High-Flux Hemodialysis for Polyclonal Free Light Chain Removal

Advantages of New Hemodialysis Membranes and Equipment

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