Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
Department of Cardiology, Cardios Research Institute, São Paulo, Brazil.
Artif Organs. 2024 May;48(5):433-443. doi: 10.1111/aor.14724. Epub 2024 Feb 26.
Hypertension is one of the most critical risk factors for cardiovascular disease, which is the leading cause of death in hemodialysis (HD) patients. Medium cut-off (MCO) membrane increases the clearance of medium molecules, which could improve blood pressure (BP) control. This study aimed to compare the effect of MCO and high-flux hemodialysis membranes on BP assessed by ambulatory blood pressure monitoring (ABPM).
This is a pre-established secondary analysis of a 28-week, randomized, open-label crossover clinical trial. Patients were randomized to HD with MCO or high-flux membranes over 12 weeks, followed by a 4-week washout period, and then switched to the alternate membrane treatment for 12 weeks. ABPM was started before the HD session and ended at least 24 h later in weeks 1, 12, 16, and 28.
32 patients, 59% male, with a mean age of 52.7 years, and 40% with unknown CKD etiology, were enrolled. The dialysis vintage was 8 years, and more than 70% of the patients had hypertension. Regarding 24-h BP control, morning diastolic BP showed an increase in the high-flux compared to stability in the MCO group (interaction effect, p = 0.039). The adjusted ANOVA models showed no significant difference in the morning BP levels between the groups. Considering only the period of the HD session, patients in the MCO, compared to those in the high-flux membrane group, showed greater BP stability during dialysis, characterized by smaller variation in the pre-post HD systolic and minimum systolic BP (treatment effect, p = 0.039, and p = 0.023, respectively).
MCO membrane seems to have a beneficial effect on morning BP and favors better BP stability during HD sessions.
高血压是心血管疾病最重要的危险因素之一，而心血管疾病是血液透析（HD）患者的主要死亡原因。中截留（MCO）膜可增加中分子的清除率，从而改善血压（BP）控制。本研究旨在比较 MCO 和高通量血液透析膜对动态血压监测（ABPM）评估的 BP 的影响。
这是一项为期 28 周、随机、开放标签交叉临床试验的预先设定的二次分析。患者被随机分为 MCO 或高通量膜 HD 治疗 12 周，随后进行 4 周洗脱期，然后切换至另一种膜治疗 12 周。ABPM 在 HD 治疗前开始，在第 1、12、16 和 28 周至少 24 小时后结束。
共纳入 32 例患者，59%为男性，平均年龄 52.7 岁，40%的病因未知，透析龄为 8 年，超过 70%的患者患有高血压。对于 24 小时 BP 控制，与 MCO 组的稳定性相比，高通量组的晨间舒张压有所增加（交互效应，p=0.039）。调整后的 ANOVA 模型显示两组间晨间 BP 水平无显著差异。仅考虑 HD 治疗期间，与高通量膜组相比，MCO 组患者在透析期间的 BP 更稳定，表现在 HD 前后收缩压和最小收缩压的变化更小（治疗效应，p=0.039 和 p=0.023）。
MCO 膜似乎对晨间 BP 有有益影响，并有利于 HD 治疗期间更好的 BP 稳定性。
