Nephrology Department, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
Nephrology Department, Hakkari State Hospital, Hakkari, Turkey.
Blood Purif. 2020;49(6):733-742. doi: 10.1159/000508061. Epub 2020 Jul 7.
Removal of uremic toxins is a main objective of hemodialysis; however, whether high-flux and medium cut-off (MCO) membranes differ as regards removal of middle and large uremic toxins is not clear.
To compare medium cut-off and high-flux dialyzers as regards their intra- and interdialysis effect on circulating levels of middle and large uremic toxins and serum albumin.
Fifty-two patients were randomized to have hemodialysis with either 3 months of high-flux dialyzer followed by 3 months of MCO or vice versa. Blood samples were taken before and after dialysis at the first and last sessions of each dialyzer for analyses of middle and large uremic toxins including inflammatory mediators and vascular endothelial growth factor (VEGF), and serum albumin.
Reduction rates were higher, and postdialysis levels of β-2 microglobulin, free kappa and lambda light chains, and myoglobulin were lower at the first and last sessions with MCO dialyzers compared to high-flux dialyzers (p < 0.05 for all). Last session predialysis levels of β-2 microglobulin, free kappa light chain, and free lambda light chain were lower than first session predialysis levels in MCO dialyzers as compared to high-flux dialyzers (p < 0.05 for all). Last session levels of interleukin-6, interleukin-10, interleukin-17, and interferon-gamma did not differ between dialyzers (p > 0.05 for all). VEGF level was lower in the MCO group compared to the high-flux group (p = 0.043). Last session level of serum albumin with MCO dialyzers was lower than that with high-flux dialyzers (3.62 [3.45-3.88] vs. 3.78 [3.58-4.02] g/L) (p = 0.04) and 6.7% lower (p < 0.001) than at the first session of MCO dialyzers.
The decline in circulating levels of several middle and large uremic toxins including VEGF following hemodialysis was more pronounced when using MCO membranes as compared to high-flux membranes while their effect on inflammatory molecules was similar.
清除尿毒症毒素是血液透析的主要目标；然而，高通量和中截留（MCO）膜在清除中大分子尿毒症毒素方面是否存在差异尚不清楚。
比较中截留和高通量透析器对中大分子尿毒症毒素和血清白蛋白的透析内和透析间循环水平的影响。
52 名患者被随机分为 3 个月高通量透析器组和 3 个月 MCO 透析器组，然后进行交换。在每个透析器的第一次和最后一次透析前后采集血液样本，分析中大分子尿毒症毒素，包括炎症介质和血管内皮生长因子（VEGF）以及血清白蛋白。
MCO 透析器在第一次和最后一次透析时β-2 微球蛋白、游离κ和λ轻链以及肌球蛋白的清除率较高，且透析后水平较低（与高通量透析器相比，所有 p 值均<0.05）。与高通量透析器相比，MCO 透析器的最后一次透析前β-2 微球蛋白、游离κ轻链和游离λ轻链的水平较第一次透析前降低（所有 p 值均<0.05）。最后一次透析时白细胞介素-6、白细胞介素-10、白细胞介素-17 和干扰素-γ在两种透析器之间无差异（所有 p 值均>0.05）。与高通量组相比，MCO 组的 VEGF 水平较低（p=0.043）。MCO 透析器的最后一次透析时血清白蛋白水平低于高通量透析器（3.62[3.45-3.88]比 3.78[3.58-4.02]g/L）（p=0.04），比 MCO 透析器的第一次透析时低 6.7%（p<0.001）。
与高通量膜相比，使用 MCO 膜进行血液透析后，包括 VEGF 在内的几种中大分子尿毒症毒素的循环水平下降更为明显，而对炎症分子的影响则相似。
