Kidney Week

Abstract: PO0926

Comparative Effectiveness Between Novel Medium Cut-Off Membrane Hemodialysis and Mixed-Dilution Online Hemodiafiltration on Middle Molecule Uremic Toxins Reduction: A Prospective Cross-Over Study

Session Information

• Leveraging Technology and Innovation to Predict Events and Improve Dialysis Delivery
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Eiamcharoenying, Jirarat, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Jirarat Eiamcharoenying, MD

• Chariyavilaskul, Pajaree, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Pajaree Chariyavilaskul,

• Takkavatakarn, Kullaya, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Kullaya Takkavatakarn,

• Susantitaphong, Paweena, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Paweena Susantitaphong,

• Avihingsanon, Yingyos, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Yingyos Avihingsanon,

• Eiam-Ong, Somchai, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Somchai Eiam-Ong,

• Tiranathanagul, Khajohn, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Khajohn Tiranathanagul,

Background

Mixed-dilution online hemodiafiltration(mixed HDF), one of the best hemodialysis(HD) modes, provides superior removal of middle molecule uremic toxins to standard HD using high flux dialyzer. Due to the limited availabilities and high cost of HDF, we performed standard HD utilizing a novel medium cut-off membrane with a larger pore size and compared the effectiveness in removal of middle molecule uremic toxins with mixed HDF.

Methods

A prospective cross-over randomized controlled trial was conducted in 14 prevalent HDF patients who were randomly allocated into group1 (n=7): mixed-dilution online HDF with high flux dialyzer ELISIO21H and group2 (n=7): standard HD with MCO membrane, Theranova 500. In this 8-week study, the primary outcome was a reduction ratio(RR) of Beta₂-microglobulin (B₂M). Other small to middle molecules and protein-bound uremic toxins reduction ratio, dialysate albumin loss, and nutritional parameters were also compared.

Results

In this 8-week study, B₂M RR from both modalities was higher than the survival benefit cut-point of 80%. In comparison, B₂M RR was slightly lower but significant in MCO HD than mixed HDF (82.57+5.34% vs 85.12±3.87%, respectively) with the mean difference of 2.55 (95% confidence interval [CI], -4.07 to -1.03; P=0.001). The spKt/Vurea and URR, a small uremic toxin removal marker, were comparable. κFLC and Indoxyl sulfate RR also were similar in mixed HDF and MCO HD. Whereas RR of the larger middle molecule uremic toxin, Alpha₁M and λFLC was lower with mixed HDF compare to MCO HD (30.13+15.90 vs 41.49+11.46 and 40.85+13.92 vs 50.81+13.18, respectively; P <0.001). Dialysate albumin loss was 3.51 g/session with MCO HD and 0.58 g/session with mixed HDF (P=0.025). Regarding, nutritional parameter, serum albumin levels were not different.

Conclusion

Mixed HDF and MCO HD provided the RR values of B₂M and small uremic toxins above the recommended cut-point. Despite mixed HDF provided higher B₂M RR, MCO HD also provided more performance in the clearance of the larger middle molecules, particularly a₁M and λFLC. However, mixed HDF loss lower albumin than MCO HD. Therefore, both techniques can be used as alternative options.

Funding

• Government Support – Non-U.S.