Kidney Week

Abstract: SA-PO406

Comparative Effectiveness in Removing Uremic Toxins Between Hemodialysis With Reuse and Single-Use Super High-Flux Dialyzer

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

• Prapunwatana, Piyapun, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand

Piyapun Prapunwatana,

• Chariyavilaskul, Pajaree, Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Pajaree Chariyavilaskul,

• Susantitaphong, Paweena, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand

Paweena Susantitaphong,

• Avihingsanon, Yingyos, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand

Yingyos Avihingsanon,

• Eiam-Ong, Somchai, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand

Somchai Eiam-Ong,

• Tiranathanagul, Khajohn, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand

Khajohn Tiranathanagul,

Background

Although hemodialysis (HD) with single use super high-flux dialyzer (SHF) provided comparable uremic toxin removing efficacy of both small (such as β2-microglobulin, β2M) and large (for example λ-free light chain, FLC) middle molecules to high volume post-dilution online hemodiafiltration, the single use SHF is expensive. The present study was conducted to compare uremic toxin removing effectiveness between HD with reuse SHF and single-use SHF.

Methods

In this single center prospective study, 5 stable thrice-a-week HD patients underwent 3 periods of HD with reuse SHF dialyzer (ELISIO-21 HX), reprocessed with peracetic acid. In each period, one SHF dialyzer was maximally reused for 15 times and each patient utilized 2-4 SHF dialyzers for the whole study. The RR values of β2M and λ-FLC were compared between the 1^st use and the 2^nd, 5^th, 10^th, and 15^th use. The 1^st use of each SHF dialyzer was utilized to represent the single-use SHF dialyzer. Dialysate albumin lost and serum albumin were assessed.

Results

A total of 15 dialyzers were analyzed. The RR of β2M (should be ≥ 80%) was comparable between the 1^st use and 15^th use (85.5 ± 5.9% vs 82.5 ± 3.5%). The λ-FLC RR (should be ≥ 40%) was 50.4 ± 4.9% at the 1^st use which was significantly dropped to 40.0 ± 5.8% and 32.3 ± 5.5% at the 5^th and 15^th use, respectively (p < 0.001). Dialysate albumin loss was significantly decreased from 1.01 g at the 1^st use to 0.19 and 0.06 g at the 2^nd and 5^th use and undetectable after the 10^th use. No statistically significant changes in serum albumin and Kt/V were found.

Conclusion

HD with reuse SHF dialyzer provided comparable ability to remove β2M to single use SHF while the effectiveness in removing λ-FLC was gradually reduced after reuse. The removal of λ-FLC in the 5^th use SHF was still comparable to high-volume online HDF. In conclusion, HD with reuse SHF dialyzer reprocessed with peracetic acid can be an alternative method to single use SHF with similar efficacy to high-volume online HDF at the 5^th use.

Funding

• Private Foundation Support