Abstract: SA-PO407
The Efficacy of Post-Dilution Online Hemodiafiltration and Medium Cut-Off Dialyser on the Removal of Protein-Bound Uremic Toxins
Session Information
- Hemodialysis and Frequent Dialysis: Clearance, Technology, Infection
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Moon, Ju young, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of)
- Kim, Yang gyun, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of)
- Jung, Su Woong, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of)
- Kim, Dae Kyu, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of)
- Lee, Sangho, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of)
- Jung, Gun Tae, Department of Applied Chemistry, Institute of Natural Science, Global Center for Pharmaceutical Ingredient Materials, Kyung Hee University, Seoul, Korea (the Republic of)
- Kim, Kwang Pyo, Department of Applied Chemistry, Institute of Natural Science, Global Center for Pharmaceutical Ingredient Materials, Kyung Hee University, Seoul, Korea (the Republic of)
- Jo, Young-Il, Konkuk University Medical Center, Gwangjin-gu, Seoul, Korea (the Republic of)
- Jin, Kyubok, Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
- Kim, Yaerim, Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
Background
The accumulation of protein-bound uremic toxins(PBUT), which is not easily removed in conventional hemodialysis (HD), is associated with increased cardiovascular outcomes in dialysis patients. High-efficiency HD is known to eliminate uremic toxins more efficiently, but data regarding PBUTs and dialysis modalities, especially medium cut-off (MCO) membrane, is scarce. Therefore, this study was designed to assess the efficacy of PBUTs clearance according to dialysis modalities.
Methods
In this prospective cross over multicenter study, dialysis removal of uremic toxins including urea, lambda free light chain(λ-FLC), beta 2-microglobulin(β2MG), indoxyl sulfate(IS), and p-cresyl sulfate(pCS) were measured in the 22 HD patients on high-flux HD (HF-HD) with FX CorDiax80, post-dilution online hemodiafiltration (Post-OL-HDF) with Fx CorDiax800, MCD-HD with Theranova 500 over three weeks each (Figure 1).
Results
The average convection volume in Post-OL-HDF was 21.4±1.8L per session. The reduction rate(RR) of middle-molecular weight uremic toxins was significantly higher in MCO-HD and Post-OL-HDF than in HF-HD. The RR of λ-FLC was higher (p=0.001), while the RR of B2MG was lower (p=0.004) in MCO-HD than in Post-OL-HDF. The dialysate albumin was highest in MCO-HD (2547.3±968.3mg/session), followed by Post-OL-HDF (778.3±313.2mg/session) and HF-HD (59.9±70.8mg/session). Post dialysis serum levels of IS (HF-HD: 15.3±10.4 mg/L, Post-OL-HDF: 12.9±6.8 mg/L in, MCO-HD: 13.1±7.1 mg/L) and pCS (HF-HD: 26.6±12.3 mg/L, Post-OL-HDF: 24.8±14.1 mg/L, MCO-HD: 23.4±13.7 mg/L) were not statistically different. Total solute removal of IS (HF-HD: 95.0±96.0 mg, Post-OL-HDF: 83.6±13.0 mg, MCO-HD: 74.3±66.8 mg), pCS (HF-HD: 114.6±58.1 mg, Post-OL-HDF: 126.2±69.5mg, MCO-HD: 101.7±57.4 mg), and dialytic clearance of IS (HF-HD: 22.1±19.9 mL/min, Post-OL-HDF: 19.5±17.2 mL/min, MCO-HD: 19.6±15.8 mL/min), pCS (HF-HD: 13.6±2.8 mL/min, Post-OL-HDF: 15.3±3.2 mL/min, MCO-HD: 14.1±3.9 mL/min) also did not show a significant difference.
Conclusion
This study shows no significant difference in the removal of PBUTs according to three dialysis modalities, even though albumin removal was the highest in MCO-HD.