Performance of hemodialysis with novel medium cut-off dialyzers
Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules. In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as f...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2017-01, Vol.32 (1), p.165-172 |
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| creator | Kirsch, Alexander H Lyko, Raphael Nilsson, Lars-Göran Beck, Werner Amdahl, Michael Lechner, Petra Schneider, Andreas Wanner, Christoph Rosenkranz, Alexander R Krieter, Detlef H |
| description | Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules.
In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments.
MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF.
MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC. |
| doi_str_mv | 10.1093/ndt/gfw310 |
| format | Article |
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In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments.
MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF.
MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfw310</identifier><identifier>PMID: 27587605</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Albumins - analysis ; Alpha-Globulins - analysis ; Cross-Over Studies ; Female ; Hemodiafiltration - methods ; Humans ; Immunoglobulin lambda-Chains - analysis ; Male ; Membranes, Artificial ; Middle Aged ; Original ; Permeability ; Pilot Projects ; Prospective Studies ; Renal Dialysis - methods</subject><ispartof>Nephrology, dialysis, transplantation, 2017-01, Vol.32 (1), p.165-172</ispartof><rights>The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA.</rights><rights>The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-147f08a12c19c18cb0a8afda6a5af10f09c4e54640a2905db90b211f7acc08403</citedby><cites>FETCH-LOGICAL-c378t-147f08a12c19c18cb0a8afda6a5af10f09c4e54640a2905db90b211f7acc08403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27587605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirsch, Alexander H</creatorcontrib><creatorcontrib>Lyko, Raphael</creatorcontrib><creatorcontrib>Nilsson, Lars-Göran</creatorcontrib><creatorcontrib>Beck, Werner</creatorcontrib><creatorcontrib>Amdahl, Michael</creatorcontrib><creatorcontrib>Lechner, Petra</creatorcontrib><creatorcontrib>Schneider, Andreas</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><creatorcontrib>Rosenkranz, Alexander R</creatorcontrib><creatorcontrib>Krieter, Detlef H</creatorcontrib><title>Performance of hemodialysis with novel medium cut-off dialyzers</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules.
In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments.
MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF.
MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC.</description><subject>Aged</subject><subject>Albumins - analysis</subject><subject>Alpha-Globulins - analysis</subject><subject>Cross-Over Studies</subject><subject>Female</subject><subject>Hemodiafiltration - methods</subject><subject>Humans</subject><subject>Immunoglobulin lambda-Chains - analysis</subject><subject>Male</subject><subject>Membranes, Artificial</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Permeability</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Renal Dialysis - methods</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkM9LwzAYhoMobk4v_gHSowh1X9qmSS6KDH_BQA96DmmabJG2mUm7Mf96OzeHnr7D-_B-Lw9C5xiuMfB03JTteGZWKYYDNMRZDnGSMnKIhn2IYyDAB-gkhA8A4Amlx2iQUMJoDmSIbl-1N87XslE6ciaa69qVVlbrYEO0su08atxSV1GtS9vVkera2BkT_SBf2odTdGRkFfTZ7o7Q-8P92-Qpnr48Pk_uprFKKWtjnFEDTOJEYa4wUwVIJk0pc0mkwWCAq0yTLM9AJhxIWXAoEowNlUoByyAdoZtt76Ir-i1KN62XlVh4W0u_Fk5a8T9p7FzM3FIQltKMJ33B5a7Au89Oh1bUNihdVbLRrgsCM8IpZoxu0KstqrwLwWuzf4NBbIyL3rjYGu_hi7_D9uiv4vQbuol-ww</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Kirsch, Alexander H</creator><creator>Lyko, Raphael</creator><creator>Nilsson, Lars-Göran</creator><creator>Beck, Werner</creator><creator>Amdahl, Michael</creator><creator>Lechner, Petra</creator><creator>Schneider, Andreas</creator><creator>Wanner, Christoph</creator><creator>Rosenkranz, Alexander R</creator><creator>Krieter, Detlef H</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170101</creationdate><title>Performance of hemodialysis with novel medium cut-off dialyzers</title><author>Kirsch, Alexander H ; Lyko, Raphael ; Nilsson, Lars-Göran ; Beck, Werner ; Amdahl, Michael ; Lechner, Petra ; Schneider, Andreas ; Wanner, Christoph ; Rosenkranz, Alexander R ; Krieter, Detlef H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-147f08a12c19c18cb0a8afda6a5af10f09c4e54640a2905db90b211f7acc08403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Albumins - analysis</topic><topic>Alpha-Globulins - analysis</topic><topic>Cross-Over Studies</topic><topic>Female</topic><topic>Hemodiafiltration - methods</topic><topic>Humans</topic><topic>Immunoglobulin lambda-Chains - analysis</topic><topic>Male</topic><topic>Membranes, Artificial</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Permeability</topic><topic>Pilot Projects</topic><topic>Prospective Studies</topic><topic>Renal Dialysis - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirsch, Alexander H</creatorcontrib><creatorcontrib>Lyko, Raphael</creatorcontrib><creatorcontrib>Nilsson, Lars-Göran</creatorcontrib><creatorcontrib>Beck, Werner</creatorcontrib><creatorcontrib>Amdahl, Michael</creatorcontrib><creatorcontrib>Lechner, Petra</creatorcontrib><creatorcontrib>Schneider, Andreas</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><creatorcontrib>Rosenkranz, Alexander R</creatorcontrib><creatorcontrib>Krieter, Detlef H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirsch, Alexander H</au><au>Lyko, Raphael</au><au>Nilsson, Lars-Göran</au><au>Beck, Werner</au><au>Amdahl, Michael</au><au>Lechner, Petra</au><au>Schneider, Andreas</au><au>Wanner, Christoph</au><au>Rosenkranz, Alexander R</au><au>Krieter, Detlef H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Performance of hemodialysis with novel medium cut-off dialyzers</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>32</volume><issue>1</issue><spage>165</spage><epage>172</epage><pages>165-172</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><abstract>Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules.
In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments.
MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF.
MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>27587605</pmid><doi>10.1093/ndt/gfw310</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Nephrology, dialysis, transplantation, 2017-01, Vol.32 (1), p.165-172 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Albumins - analysis Alpha-Globulins - analysis Cross-Over Studies Female Hemodiafiltration - methods Humans Immunoglobulin lambda-Chains - analysis Male Membranes, Artificial Middle Aged Original Permeability Pilot Projects Prospective Studies Renal Dialysis - methods |
| title | Performance of hemodialysis with novel medium cut-off dialyzers |
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