Renal Therapy Services-Latin America, Bogotá, Colombia,
Renal Therapy Services-Latin America, Bogotá, Colombia.
Blood Purif. 2021;50(1):110-118. doi: 10.1159/000508803. Epub 2020 Nov 11.
A new generation of hemodialysis (HD) membranes called medium cut-off (MCO) membranes possesses enhanced capacities for middle molecule clearance, which have been associated with adverse outcomes in this population. These improvements could potentially positively impact patient-reported outcomes (PROs).
The objective of this study was to evaluate the impact of MCO membranes on PROs in a cohort of HD patients in Colombia.
This was a prospective, multicenter, observational cohort study of 992 patients from 12 renal clinics in Colombia who were switched from high-flux HD to MCO therapy and observed for 12 months. Changes in Kidney Disease Quality of Life 36-Item Short Form Survey (KDQoL-SF36) domains, Dialysis Symptom Index (DSI), and restless legs syndrome (RLS) 12 months after switching to MCO membranes were compared with time on high-flux membranes. Repeated measures of ANOVA were used to evaluate changes in KDQoL-SF36 scores; severity scoring was used to assess DSI changes over time; Cochran's Q test was used to evaluate changes in frequency of diagnostic criteria of RLS.
During 12 months of follow-up, 3 of 5 KDQoL-SF36 domains improved compared with baseline: symptoms (p < 0.0001), effects of kidney disease (p < 0.0001), and burden of kidney disease (p < 0.001). The proportion of patients diagnosed with RLS significantly decreased from 22.1% at baseline to 10% at 12 months (p < 0.0001). No significant differences in the number of symptoms (DSI, p = 0.1) were observed, although their severity decreased (p = 0.009).
In conventional HD patients, the expanded clearance of large middle molecules with MCO-HD membranes was associated with higher health-related quality of life scores and a decrease in the prevalence of RLS.
新一代的血液透析（HD）膜，即中分子截留（MCO）膜，具有增强的中分子清除能力，这与该人群的不良结局有关。这些改进可能会对患者报告的结果（PRO）产生积极影响。
本研究旨在评估 MCO 膜对哥伦比亚血液透析患者 PRO 的影响。
这是一项前瞻性、多中心、观察性队列研究，纳入了来自哥伦比亚 12 个肾脏诊所的 992 名患者，这些患者从高通量 HD 切换到 MCO 治疗，并观察了 12 个月。比较了切换到 MCO 膜后 12 个月时 Kidney Disease Quality of Life 36-Item Short Form Survey（KDQoL-SF36）各领域、透析症状指数（DSI）和不安腿综合征（RLS）的变化与高通量膜时的变化。采用重复测量方差分析评估 KDQoL-SF36 评分的变化；采用严重程度评分评估 DSI 随时间的变化；采用 Cochran's Q 检验评估 RLS 诊断标准频率的变化。
在 12 个月的随访期间，与基线相比，KDQoL-SF36 的 5 个领域中有 3 个得到改善：症状（p < 0.0001）、肾脏疾病的影响（p < 0.0001）和肾脏疾病的负担（p < 0.001）。RLS 的诊断率从基线时的 22.1%显著下降到 12 个月时的 10%（p < 0.0001）。虽然 DSI 症状的数量没有显著差异（p = 0.1），但其严重程度有所下降（p = 0.009）。
在常规 HD 患者中，MCO-HD 膜扩大清除大中分子与更高的健康相关生活质量评分和 RLS 患病率下降有关。
