Lindgren Anna, Fjellstedt Erik, Christensson Anders
Department of Nephrology, Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Int J Nephrol Renovasc Dis. 2020 Oct 27;13:273-280. doi: 10.2147/IJNRD.S263110. eCollection 2020.
Conventional hemodialysis (HD) treatment has an acceptable removal of small uremic molecules, but so-called "middle molecules" in the range of 0.5-60 kDa are poorly cleared with HD compared to a native kidney, which may contribute to morbidity in the dialysis population. Hemodiafiltration (HDF) has a better removal of middle molecules compared to HD but is technically demanding and requires well-functioning dialysis access. The newly introduced medium cutoff (MCO) filters have been developed to enhance middle molecule clearance in HD-mode. The aim of this study was to compare reduction ratios (RRs) of molecules with different molecular weights (0.06-150 kDa) during dialysis with MCO dialyzer (used in HD-mode) compared to online-hemodiafiltration (ol-HDF) treatment with a conventional high-flux dialyzer.
This is a prospective controlled single-center cross-over study, including 16 patients in Malmö, Sweden. All patients had ongoing post-dilution ol-HDF treatment before the study. The study compared reduction ratios of small-, middle-, and large-sized molecules during a single 4h dialysis treatment with post-dilution ol-HDF (Polyflux 210H) to a 4h dialysis treatment with MCO dialyzer (Theranova 500) in HD-mode. Between treatments, the patients had a washout period of at least two weeks of their ordinary HDF treatment to reach their ordinary steady state.
ol-HDF had significantly higher RR for cystatin C (13 kDa), compared to MCO (RR 68.1 vs 65.8, p=0.003), during a 4h dialysis treatment (mean convection volume of 24.5 L for HDF, and mean Q of 324 mL/min for HDF and 323 mL/min for MCO). There was no significant difference in the RR for other middle molecules, or for smaller or larger molecules.
Overall, the RRs were comparable for ol-HDF and MCO-HD. There was a slightly higher RR of cystatin C (a small middle molecule) for HDF compared to MCO but no difference in other measured molecules.
传统血液透析（HD）治疗对小分子尿毒症毒素有可接受的清除效果，但与天然肾脏相比，HD对分子量在0.5 - 60 kDa范围内的所谓“中分子”清除效果较差，这可能导致透析人群发病。与HD相比，血液透析滤过（HDF）对中分子的清除效果更好，但技术要求高，需要功能良好的透析通路。新推出的中等截留量（MCO）滤器旨在提高HD模式下中分子的清除率。本研究的目的是比较使用MCO透析器（用于HD模式）与使用传统高通量透析器进行在线血液透析滤过（ol - HDF）治疗时，不同分子量（0.06 - 150 kDa）分子的清除率（RR）。
这是一项前瞻性对照单中心交叉研究，纳入了瑞典马尔默的16名患者。所有患者在研究前均接受持续的后置稀释ol - HDF治疗。该研究比较了单次4小时透析治疗中，后置稀释ol - HDF（Polyflux 210H）与HD模式下使用MCO透析器（Theranova 500）进行4小时透析治疗时，小分子、中分子和大分子的清除率。两次治疗之间，患者有至少两周的洗脱期，以恢复其普通HDF治疗的正常稳态。
在4小时透析治疗期间（HDF的平均对流体积为24.5 L，HDF的平均血流量为324 mL/min，MCO为323 mL/min），与MCO相比，ol - HDF对胱抑素C（13 kDa）的清除率显著更高（RR分别为68.1和65.8，p = 0.003）。其他中分子、小分子或大分子的清除率无显著差异。
总体而言，ol - HDF和MCO - HD的清除率相当。与MCO相比，HDF对胱抑素C（一种小中分子）的清除率略高，但在其他检测分子上无差异。
