Kim Chang Seong, Joo Soo Yeon, Choi Hong Sang, Bae Eun Hui, Ma Seong Kwon, Kim Soo Wan
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Kidney Res Clin Pract. 2023 Nov;42(6):712-722. doi: 10.23876/j.krcp.21.287. Epub 2023 Jun 15.
The medium cutoff (MCO) dialyzer increases the removal of several middle molecules more effectively than high-flux hemodialysis (HD). However, comparative data addressing the efficacy and safety of MCO dialyzers vs. postdilution hemodiafiltration (HDF) in Korean patients are lacking.
Nine patients with chronic HD were included in this pre-post study. Patients underwent HD with an MCO dialyzer for 4 weeks, followed by a 2-week washout period using a high-flux dialyzer to minimize carryover effects, and then turned over to postdilution HDF for 4 weeks. Reduction ratios and differences in the uremic toxins before and after dialysis were calculated from the MCO dialysis, postdilution HDF, and high-flux HD. In the in vitro study, EA.hy926 cells were incubated with dialyzed serum.
Compared to postdilution HDF, the MCO dialyzer achieved significantly higher reduction ratios for larger middle molecules (myoglobin, kappa free light chain [κFLC], and lambda FLC [λFLC]). Similarly, the differences in myoglobin, κFLC, and λFLC concentrations before and after the last dialysis session were significantly greater in MCO dialysis than in postdilution HDF. The expression of Bax and nuclear factor κB was decreased in the serum after dialysis with the MCO dialyzer than with HDF.
Compared with high-volume postdilution HDF, MCO dialysis did not provide greater removal of molecules below 12,000 Da, whereas it was superior in the removal of larger uremic middle molecule toxins in patients with kidney failure. Moreover, these results may be expected to have an anti-apoptotic effect on the human endothelium.
中截流（MCO）透析器比高通量血液透析（HD）更有效地增加了几种中分子物质的清除。然而，在韩国患者中，关于MCO透析器与后稀释血液透析滤过（HDF）的疗效和安全性的比较数据尚缺乏。
本前后对照研究纳入了9例慢性血液透析患者。患者先用MCO透析器进行血液透析4周，然后使用高通量透析器进行2周的洗脱期，以尽量减少残留效应，之后转为后稀释血液透析滤过4周。根据MCO透析、后稀释血液透析滤过和高通量血液透析计算透析前后尿毒症毒素的降低率和差异。在体外研究中，将EA.hy926细胞与透析后的血清一起孵育。
与后稀释血液透析滤过相比，MCO透析器对较大的中分子物质（肌红蛋白、κ游离轻链[κFLC]和λ游离轻链[λFLC]）的降低率显著更高。同样，在最后一次透析 session 前后，MCO透析中肌红蛋白、κFLC和λFLC浓度的差异明显大于后稀释血液透析滤过。与血液透析滤过相比，使用MCO透析器透析后血清中Bax和核因子κB的表达降低。
与大容量后稀释血液透析滤过相比，MCO透析对分子量低于12,000 Da的分子清除效果并不更好，而在清除肾衰竭患者中较大的尿毒症中分子毒素方面更具优势。此外，这些结果可能有望对人内皮细胞产生抗凋亡作用。
