Marcello Matteo, Simonini Marco, Lorenzin Anna, Corradi Valentina, Virzì Grazia Maria, Caprara Carlotta, Brendolan Alessandra, Benedetti Claudia, Lentini Paolo, Zanella Monica, Ronco Claudio
Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy.
International Renal Research Institute of Vicenza, 36100 Vicenza, Italy.
J Clin Med. 2025 Mar 7;14(6):1798. doi: 10.3390/jcm14061798.
Removal of large uraemic toxins is still a challenge. Haemodiafiltration (HDF) has produced some results, although large convective volume, optimal vascular access to increase the blood flow rate and strict water quality management are required. Medium cut-off, high-retention-onset membranes have been recently developed, introducing the concept therapy called expanded haemodialysis (HDx). Furthermore, vitamin E-coated membrane has potential beneficial effects on inflammation and oxidative stress. A prospective longitudinal multicentre study was conducted for 3 months among 24 chronic haemodialysis patients. Patients were randomly assigned into either HDF with high-flux membrane or HDx with Theranova or ViE-X membrane. The primary goal was to assess albumin loss among the three types of dialyzers. Secondary goals included assessment of depurative efficacy for uraemic toxins and clinical outcomes. Mean albumin loss was significantly higher in patients undergoing HDx with Theranova membrane, without any difference in serum albumin concentration among the three groups. Instantaneous clearance of small and middle molecules was significantly higher in patients undergoing HDF, but we did not find differences in removal ratio and Kt/V. Reduction in the erythropoietin resistance index was observed in patients treated with ViE-X membrane due to their lower dialysis vintage. The higher albumin loss during HDx has no effects on pre-dialysis serum albumin. HDx with Theranova in the presence of lower session length, lower Qb, lower convective dose, and lower instantaneous clearance reached the same dialysis efficacy compared to HDF.
清除大分子量尿毒症毒素仍然是一项挑战。血液透析滤过（HDF）已取得了一些成果，不过需要大的对流体积、优化血管通路以提高血流速度以及严格的水质管理。最近开发出了中截留量、高保留起始通量的膜，引入了一种名为扩展血液透析（HDx）的概念疗法。此外，维生素E包被膜对炎症和氧化应激可能具有有益作用。对24例慢性血液透析患者进行了一项为期3个月的前瞻性纵向多中心研究。患者被随机分为接受高通量膜HDF治疗组或接受使用Theranova或ViE-X膜的HDx治疗组。主要目标是评估三种透析器中的白蛋白丢失情况。次要目标包括评估尿毒症毒素的清除效果和临床结局。使用Theranova膜进行HDx治疗的患者平均白蛋白丢失显著更高，三组间血清白蛋白浓度无差异。接受HDF治疗的患者中小分子和中分子的即时清除率显著更高，但我们未发现清除率和Kt/V有差异。使用ViE-X膜治疗的患者由于透析时间较短，促红细胞生成素抵抗指数有所降低。HDx期间较高的白蛋白丢失对透析前血清白蛋白无影响。与HDF相比，使用Theranova进行HDx治疗时，尽管治疗时间较短、血流量较低、对流剂量较低且即时清除率较低，但仍能达到相同的透析效果。
