Background: A novel class of membranes, medium cut-off (MCO) membranes, has recently been designed to achieve interesting removal capacities for middle and large middle molecules in hemodialysis (HD) treatments. The few studies published to date have reported contradictory results regarding middle-sized molecules when comparing MCO dialyzers versus dialyzers used in online hemodiafiltration (OL-HDF). Methods: A prospective, single-center study was carried out in 22 patients. Each patient underwent 9 dialysis sessions with routine dialysis parameters, one with an MCO dialyzer in HD and the other 8 with different dialyzers in OL-HDF. The removal ratio (RR) of urea, creatinine, β2-microglobulin, myoglobin, prolactin, α1-microglobulin, α1-acid glycoprotein, and albumin was intraindividually compared. Albumin loss in dialysate was measured. We propose a global removal score ([ureaRR + β2-microglobulinRR + myoglobinRR + prolactinRR + α1-microglobulinRR + α1-acid glycoproteinRR]/6 – albuminRR) as a new tool for measuring dialyzer effectiveness. Results: No significant differences in the RRs of small and middle molecular range molecules were observed between the MCO vs. OL-HDF dialyzers (range 60–80%). Lower RRs were found for α1-microglobulin and α1-acid glycoprotein without significant differences. The albumin RR was < 11% and dialysate albumin loss was < 3.5 g in all situations without significant differences. The global removal score was 54.9 ± 4.8% with the MCO dialyzer without significant differences. Conclusions: Removal of a wide range of molecular weights, calculated with the proposed global removal score, was almost equal with the MCO dialyzer in HD treatment compared with 8 high-flux dialyzers in high-volume OL-HDF without relevant changes in albumin loss. The global removal score could be a new tool to evaluate the effectiveness of dialyzers and/or different treatment modalities.

Sichart JM, Moeller S. Utilization of hemodiafiltration as treatment modality in renal replacement therapy for end-stage renal disease patients–a global perspective. Contrib Nephrol. 2011; 175: 163–9.
Maduell F. Hemodiafiltration. Hemodial Int. 2005 Jan; 9(1): 47–55.
Canaud B, Vienken J, Ash S, Ward RA; Kidney Health Initiative HDF Workgroup. Hemodiafiltration to Address Unmet Medical Needs ESKD Patients. Clin J Am Soc Nephrol. 2018 Sep; 13(9): 1435–43.
Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, et al.; ESHOL Study Group. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol. 2013 Feb; 24(3): 487–97.
Peters SA, Bots ML, Canaud B, Davenport A, Grooteman MP, Kircelli F, et al.; HDF Pooling Project Investigators. Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant. 2016 Jun; 31(6): 978-984.
Nistor I, Palmer SC, Craig JC, Saglimbene V, Vecchio M, Covic A, et al. Convective versus diffusive dialysis therapies for chronic kidney failure: an updated systematic review of randomized controlled trials. Am J Kidney Dis. 2014 Jun; 63(6): 954–67.
Mostovaya IM, Blankestijn PJ, Bots ML, Covic A, Davenport A, Grooteman MP, et al.; EUDIAL1 – an official ERA-EDTA Working Group. Clinical evidence on hemodiafiltration: a systematic review and a meta-analysis. Semin Dial. 2014 Mar; 27(2): 119–27.
Mercadal L, Franck JE, Metzger M, Urena Torres P, de Cornelissen F, Edet S, et al.; REIN Registry. Hemodiafiltration versus hemodialysis and survival in patients with ESRD: the French renal epidemiology and information network (REIN) registry. Am J Kidney Dis. 2016 Aug; 68(2): 247–55.
See EJ, Hedley J, Agar JW, Hawley CM, Johnson DW, Kelly PJ, et al. Patient survival on haemodiafiltration and haemodialysis: a cohort study using the Australia and New Zealand Dialysis and Transplant Registry. Nephrol Dial Transplant. 2019 Feb 1; 34(2): 326-338.
Boschetti-de-Fierro A, Voigt M, Storr M, Krause B. Extended characterization of a new class of membranes for blood purification: the high cut-off membranes. Int J Artif Organs. 2013 Jul; 36(7): 455–63.
Krieter DH, Canaud B. High permeability of dialysis membranes: what is the limit of albumin loss? Nephrol Dial Transplant. 2003 Apr; 18(4): 651–4.
Ronco C, La Manna G. Expanded hemodialysis: a new therapy for a new class of membranes. Contrib Nephrol. 2017; 190: 124–33.
Ronco C, Marchionna N, Brendolan A, Neri M, Lorenzin A, Martínez Rueda AJ. Expanded haemodialysis: from operational mechanism to clinical results. Nephrol Dial Transplant. 2018 Oct; 33 suppl_3:iii41–7.
Kirsch AH, Lyko R, Nilsson LG, Beck W, Amdahl M, Lechner P, et al. Performance of hemodialysis with novel medium cut-off dialyzers. Nephrol Dial Transplant. 2017 Jan; 32(1): 165–72.
Belmouaz M, Diolez J, Bauwens M, Duthe F, Ecotiere L, Desport E, et al. Comparison of hemodialysis with medium cut-off dialyzer and on-line hemodiafiltration on the removal of small and middle-sized molecules. Clin Nephrol. 2018 Jan; 89(1): 50–6.
Reque J, Pérez Alba A, Panizo N, Sánchez-Canel JJ, Pascual MJ, Pons Prades R. Is Expanded Hemodialysis an Option to Online Hemodiafiltration for Small- and Middle-Sized Molecules Clearance? Blood Purif. 2019; 47(1-3): 126-131.
García-Prieto A, Vega A, Linares T, Abad S, Macías N, Aragoncillo I, et al. Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialysers in conventional haemodialysis and online haemodiafiltration. Clin Kidney J. 2018 Oct; 11(5): 742–6.
Potier J, Queffeulou G, Bouet J. Are all dialyzers compatible with the convective volumes suggested for postdilution online hemodiafiltration? Int J Artif Organs. 2016 Nov; 39(9): 460–70.
Maduell F, Ojeda R, Arias-Guillén M, Fontseré N, Vera M, Rodas L, et al. A new generation of cellulose triacetate suitable for online haemodiafiltration. Nefrologia. 2018 Mar - Apr; 38(2): 161–8.
Bergström J, Wehle B. No change in corrected beta 2-microglobulin concentration after cuprophane haemodialysis. Lancet. 1987 Mar; 1(8533): 628–9.
Duranton F, Cohen G, De Smet R, Rodriguez M, Jankowski J, Vanholder R, et al.; European Uremic Toxin Work Group. Normal and pathologic concentrations of uremic toxins. J Am Soc Nephrol. 2012 Jul; 23(7): 1258–70.
Ward RA. Protein-leaking membranes for hemodialysis: a new class of membranes in search of an application? J Am Soc Nephrol. 2005 Aug; 16(8): 2421–30.
Maduell F, Navarro V, Cruz MC, Torregrosa E, Garcia D, Simon V, et al. Osteocalcin and myoglobin removal in on-line hemodiafiltration versus low- and high-flux hemodialysis. Am J Kidney Dis. 2002 Sep; 40(3): 582–9.
Maduell F, Arias-Guillen M, Fontseré N, Ojeda R, Rico N, Vera M, et al. Elimination of large uremic toxins by a dialyzer specifically designed for high-volume convective therapies. Blood Purif. 2014; 37(2): 125–30.
Morena M, Jaussent A, Chalabi L, Leray-Moragues H, Chenine L, Debure A, et al.; FRENCHIE Study Investigators. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly. Kidney Int. 2017 Jun; 91(6): 1495–509.
Penne EL, van der Weerd NC, van den Dorpel MA, Grooteman MP, Lévesque R, Nubé MJ, et al.; CONTRAST Investigators. Short-term effects of online hemodiafiltration on phosphate control: a result from the randomized controlled Convective Transport Study (CONTRAST). Am J Kidney Dis. 2010 Jan; 55(1): 77–87.
Rama I, Llaudó I, Fontova P, Cerezo G, Soto C, Javierre C, et al. Online Haemodiafiltration improves inflammatory state in dialysis patients: A longitudinal Study. PLoS One. 2016 Oct; 11(10):e0164969.
Ohtake T, Oka M, Ishioka K, Honda K, Mochida Y, Maesato K, et al. Cardiovascular protective effects of on-line hemodiafiltration: comparison with conventional hemodialysis. Ther Apher Dial. 2012 Apr; 16(2): 181–8.
Bellien J, Fréguin-Bouilland C, Joannidès R, Hanoy M, Rémy-Jouet I, Monteil C, et al. High-efficiency on-line haemodiafiltration improves conduit artery endothelial function compared with high-flux haemodialysis in end-stage renal disease patients. Nephrol Dial Transplant. 2014 Feb; 29(2): 414–22.
Dekker M, Pasch A, van der Sande F, Konings C, Bachtler M, Dionisi M, et al. High-flux hemodialysis and high-volume hemodiafiltration improve serum calcification propensity. PLoS One. 2016 Apr; 11(4):e0151508.
Zickler D, Schindler R, Willy K, Martus P, Pawlak M, Storr M, et al. Medium Cut-Off (MCO) Membranes Reduce Inflammation in Chronic Dialysis Patients-A Randomized Controlled Clinical Trial. PLoS One. 2017 Jan; 12(1):e0169024.
Willy K, Girndt M, Voelkl J, Fiedler R, Martus P, Storr M, et al. Expanded Haemodialysis Therapy of Chronic Haemodialysis Patients Prevents Calcification and Apoptosis of Vascular Smooth Muscle Cells in vitro. Blood Purif. 2018; 45(1-3): 131–8.
Lorenzin A, Neri M, Lupi A, Todesco M, Santimaria M, Alghisi A, et al. Quantification of internal filtration in hollow fiber hemodialyzers with medium cut-off membrane. Blood Purif. 2018; 46(3): 196–204.
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