Blood Purification
Original Paper
New High-Cutoff Dialyzer Allows Improved Middle Molecule Clearance without an Increase in Albumin Loss: A Clinical Crossover Comparison in Extended DialysisSchmidt J.J.a · Hafer C.a · Clajus C.a · Hadem J.b · Beutel G.c · Schmidt B.M.W.a · Kielstein J.T.aaDivision of Nephrology and Hypertension, Department of Internal Medicine, bDepartment of Gastroenterology, Hepatology and Endocrinology, and cDepartment of Hematology, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
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Article / Publication Details
Received: March 28, 2012
Accepted: August 09, 2012
Published online: November 21, 2012
Issue release date: March 2013
Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 3
ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)
For additional information: https://www.karger.com/BPU
Abstract
Background: Accumulation of middle molecules is thought to have adverse effects in patients with acute kidney injury (AKI). Elimination of middle molecules by non-convective means, i.e. hemodialysis, remains difficult. The aim of the study was to investigate the removal characteristics of a new high permeability membrane in AKI patients undergoing extended dialysis (ED). Patients and Methods: We performed a prospective, crossover study comparing the EMiC2 dialyzer (1.8 m2, FMC, Germany) and AV 1000S (1.8 m2, FMC) in 11 critically ill patients with AKI. β2-Microglobulin, cystatin c, creatinine, and urea were measured before and after 0.5, 5.0 and 10 h of ED. Serum reduction ratios, dialyzer clearances, and mass in the total collected dialysate were determined. Results: Dialyzer clearance of β2-microglobulin (EMiC2: 52 ± 1.7 ml/min, AV 1000S: 41.7 ± 1.5 ml/min, p = 0.0002) and cystatin c (EMiC2: 47.2 ± 1.2 ml/min, AV 1000S: 34.2 ± 2.3 ml/min, p < 0.0001) was markedly different, as was the reduction of serum levels of β2-microglobulin (EMiC2: 54.3 ± 3.6%, AV 1000S: 39.1 ± 4.5%, p = 0.025) and cystatin c (EMiC2: 38.9 ± 2.6%, AV 1000S: 28.0 ± 3.9%, p = 0.043). Additionally, we observed a higher total amount of these substances in the collected dialysate. There was no significant difference in the total amount of albumin eliminated per treatment. Conclusion: The new EMiC2 dialyzer enhances removal of middle molecules without an increase in albumin loss. The clinical relevance of this finding needs to be determined.
© 2012 S. Karger AG, Basel
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References
- Cohen G, Glorieux G, Thornalley P, Schepers E, Meert N, Jankowski J, Jankowski V, Argiles A, Anderstam B, Brunet P, Cerini C, Dou L, Deppisch R, Marescau B, Massy Z, Perna A, Raupachova J, Rodriguez M, Stegmayr B, Vanholder R, Horl WH: Review on uraemic toxins III: recommendations for handling uraemic retention solutes in vitro – towards a standardized approach for research on uraemia. Nephrol Dial Transplant 2007;22:3381–3390.
- Vanholder R, Meert N, Schepers E, Glorieux G, Argiles A, Brunet P, Cohen G, Drueke T, Mischak H, Spasovski G, Massy Z, Jankowski J: Review on uraemic solutes II – variability in reported concentrations: causes and consequences. Nephrol Dial Transplant 2007;22:3115–3121.
- Faulhaber-Walter R, Hafer C, Jahr N, Vahlbruch J, Hoy L, Haller H, Fliser D, Kielstein JT: The Hannover Dialysis Outcome study: comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. Nephrol Dial Transplant 2009;24:2179–2186.
- Jun M, Heerspink HJ, Ninomiya T, Gallagher M, Bellomo R, Myburgh J, Finfer S, Palevsky PM, Kellum JA, Perkovic V, Cass A: Intensities of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2010;5:956–963.
- Cerda J, Ronco C: Modalities of continuous renal replacement therapy: technical and clinical considerations. Semin Dial 2009;22:114–122.
- Locatelli F, Martin-Malo A, Hannedouche T, Loureiro A, Papadimitriou M, Wizemann V, Jacobson SH, Czekalski S, Ronco C, Vanholder R: Effect of membrane permeability on survival of hemodialysis patients. J Am Soc Nephrol 2009;20:645–654.
- Tattersall J, Canaud B, Heimburger O, Pedrini L, Schneditz D, Van BW: High-flux or low-flux dialysis: a position statement following publication of the Membrane Permeability Outcome study. Nephrol Dial Transplant 2010;25:1230–1232.
- Kielstein JT, Kretschmer U, Ernst T, Hafer C, Bahr MJ, Haller H, Fliser D: Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis 2004;43:342–349.
- Kumar VA, Craig M, Depner TA, Yeun JY: Extended daily dialysis: a new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 2000;36:294–300.
- Marshall MR, Golper TA, Shaver MJ, Alam MG, Chatoth DK: Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int 2001;60:777–785.
- Fliser D, Kielstein JT: Technology insight: treatment of renal failure in the intensive care unit with extended dialysis. Nat Clin Pract Nephrol 2006;2:32–39.
-
Marshall MR, Creamer JM, Foster M, Ma TM, Mann SL, Fiaccadori E, Maggiore U, Richards B, Wilson VL, Williams AB, Rankin AP: Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries. Nephrol Dial Transplant, DOI: 10.1093/ndt/gfq694.
- Ronco C, Brendolan A, Lupi A, Metry G, Levin NW: Effects of a reduced inner diameter of hollow fibers in hemodialyzers. Kidney Int 2000;58:809–817.
- Hutchison CA, Cockwell P, Reid S, Chandler K, Mead GP, Harrison J, Hattersley J, Evans ND, Chappell MJ, Cook M, Goehl H, Storr M, Bradwell AR: Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies. J Am Soc Nephrol 2007;18:886–895.
- Canaud B, Morena M, Cristol JP, Krieter D: Beta2-microglobulin, a uremic toxin with a double meaning. Kidney Int 2006;69:1297–1299.
- Kielstein JT, Eugbers C, Bode-Boeger SM, Martens-Lobenhoffer J, Haller H, Joukhadar C, Traunmuller F, Knitsch W, Hafer C, Burkhardt O: Dosing of daptomycin in intensive care unit patients with acute kidney injury undergoing extended dialysis – a pharmacokinetic study. Nephrol Dial Transplant 2010;25:1537–1541.
- Lee D, Haase M, Haase-Fielitz A, Paizis K, Goehl H, Bellomo R: A pilot, randomized, double-blind, cross-over study of high cut-off versus high-flux dialysis membranes. Blood Purif 2009;28:365–372.
- Pellicano R, Polkinghorne KR, Kerr PG: Reduction in beta2-microglobulin with super-flux versus high-flux dialysis membranes: results of a 6-week, randomized, double-blind, crossover trial. Am J Kidney Dis 2008;52:93–101.
- Krieter DH, Falkenhain S, Chalabi L, Collins G, Lemke HD, Canaud B: Clinical cross-over comparison of mid-dilution hemodiafiltration using a novel dialyzer concept and post-dilution hemodiafiltration. Kidney Int 2005;67:349–356.
- Krieter DH, Hackl A, Rodriguez A, Chenine L, Moragues HL, Lemke HD, Wanner C, Canaud B: Protein-bound uraemic toxin removal in haemodialysis and post-dilution haemodiafiltration. Nephrol Dial Transplant 2010;25:212–218.
-
De Smet RV, Dhondt A, Eloot S, Galli F, Waterloos MA, Vanholder R: Effect of the super-flux cellulose triacetate dialyser membrane on the removal of non-protein-bound and protein-bound uraemic solutes. Nephrol Dial Transplant 2007;22:2006–2012.
External Resources
- Cheung AK, Levin NW, Greene T, Agodoa L, Bailey J, Beck G, Clark W, Levey AS, Leypoldt JK, Ornt DB, Rocco MV, Schulman G, Schwab S, Teehan B, Eknoyan G: Effects of high-flux hemodialysis on clinical outcomes: results of the HEMO study. J Am Soc Nephrol 2003;14:3251–3263.
- Cheung AK, Rocco MV, Yan G, Leypoldt JK, Levin NW, Greene T, Agodoa L, Bailey J, Beck GJ, Clark W, Levey AS, Ornt DB, Schulman G, Schwab S, Teehan B, Eknoyan G: Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. J Am Soc Nephrol 2006;17:546–555.
Article / Publication Details
Received: March 28, 2012
Accepted: August 09, 2012
Published online: November 21, 2012
Issue release date: March 2013
Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 3
ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)
For additional information: https://www.karger.com/BPU
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