Bildaci Yelda Deligoz, Esme Mert, Korucu Berfu, Erbay Ege, Yigitbasi Barkin, Dilek Banu, Senturk Zekiye Selin, Cavdar Caner, Deger Serpil Muge
Faculty of Medicine, Department of Nephrology, Dokuz Eylül University, Izmir, Turkey.
Faculty of Medicine, Department of Geriatrics, Hacettepe University, Ankara, Turkey.
Artif Organs. 2025 Aug;49(8):1332-1338. doi: 10.1111/aor.14997. Epub 2025 Mar 13.
Medium cut-off (MCO) dialyzers are designed to provide clearance of large-middle molecular weight uremic toxins and cytokines that are also responsible for the pathogenesis of sarcopenia.
To investigate the short- and long-term effects of MCO dialyzers on fat and muscle mass.
This single-center prospective, cross-over study includes 20 maintenance hemodialysis (MHD) patients treated with low-flux (LF) dialyzers. Baseline parameters were measured under LF dialyzers and repeated at 2nd week and 6th month after switching to MCO dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strength parameters were measured with ultrasound and handgrip tests.
Median skinfold thickness showed a statistically significant increase in the second week of HD with MCO dialyzers [15 mm (10, 17) to 16 mm (13.3, 19.8), p = 0.04] and remained similar in the 6th month (p = 0.08). There was a gradual increase in median mid-upper arm circumference with a significant increase in the 6th month [28 (27, 29.5), 28.5 cm (27, 30), and 30.6 cm (26.7, 32), respectively, p = 0.03]. Significant increases were detected in the measurements of all four abdominal muscle groups (p = 0.03 for rectus abdominis and external oblique; p = 0.002 for internal oblique and transversus abdominis) in the 2nd week of MCO dialyzers and remained similar in the 6th month. Median RF and GCM thicknesses also significantly increased in the 2nd week (p = 0.001 and p < 0.001, respectively). The thicknesses of the external oblique, internal oblique, transversus abdominis, and rectus femoris muscles showed no significant differences in the 6th month. We also observed significant increases in the median GCM fibril length and GCM fibril pennation (p = 0.01 and p = 0.008, respectively) in the 2nd week, which also remained similar in the 6th month. The handgrip strength test showed a gradual increase at each time point without statistical significance.
MCO dialyzers provide increased fat and muscle mass, which might be due to their better clearance of uremic toxins compared to low-flux dialyzers. This study serves as a hypothesis-generating investigation; larger randomized controlled trials are required to validate the hypothesis.
中截留量（MCO）透析器旨在清除大 - 中分子量的尿毒症毒素和细胞因子，这些物质也与肌肉减少症的发病机制有关。
研究MCO透析器对脂肪和肌肉量的短期和长期影响。
这项单中心前瞻性交叉研究纳入了20例接受低通量（LF）透析器治疗的维持性血液透析（MHD）患者。在LF透析器治疗下测量基线参数，并在切换至MCO透析器后的第2周和第6个月重复测量。用皮褶卡尺和上臂中部周长测量脂肪组织。用超声和握力测试测量肌肉厚度和力量参数。
使用MCO透析器进行血液透析的第2周，皮褶厚度中位数有统计学显著增加[15mm（10，17）至16mm（13.3，19.8），p = 0.04]，第6个月时保持相似（p = 0.08）。上臂中部周长中位数逐渐增加，第6个月时有显著增加[分别为28（27，29.5）、28.5cm（27，30）和30.6cm（26.7，32），p = 0.03]。在使用MCO透析器治疗的第2周，所有四个腹部肌肉群的测量值均有显著增加（腹直肌和腹外斜肌p = 0.03；腹内斜肌和腹横肌p = 0.002），第6个月时保持相似。第2周时，桡侧屈腕肌（RF）和肱桡肌（GCM）厚度中位数也显著增加（分别为p = 0.001和p < 0.001）。第6个月时，腹外斜肌、腹内斜肌、腹横肌和股直肌的厚度无显著差异。我们还观察到第2周时GCM纤维长度中位数和GCM纤维羽状角有显著增加（分别为p = 0.01和p = 0.008），第6个月时也保持相似。握力测试在每个时间点均呈逐渐增加趋势，但无统计学意义。
MCO透析器可增加脂肪和肌肉量，这可能是因为与低通量透析器相比，它们对尿毒症毒素的清除效果更好。本研究作为一项产生假设的调查；需要更大规模的随机对照试验来验证该假设。
