Introduction: Removal of uremic toxins is a main objective of hemodialysis; however, whether high-flux and medium cut-off (MCO) membranes differ as regards removal of middle and large uremic toxins is not clear. Objective: To compare medium cut-off and high-flux dialyzers as regards their intra- and interdialysis effect on circulating levels of middle and large uremic toxins and serum albumin. Methods: Fifty-two patients were randomized to have hemodialysis with either 3 months of high-flux dialyzer followed by 3 months of MCO or vice versa. Blood samples were taken before and after dialysis at the first and last sessions of each dialyzer for analyses of middle and large uremic toxins including inflammatory mediators and vascular endothelial growth factor (VEGF), and serum albumin. Results: Reduction rates were higher, and postdialysis levels of β-2 microglobulin, free kappa and lambda light chains, and myoglobulin were lower at the first and last sessions with MCO dialyzers compared to high-flux dialyzers (p < 0.05 for all). Last session predialysis levels of β-2 microglobulin, free kappa light chain, and free lambda light chain were lower than first session predialysis levels in MCO dialyzers as compared to high-flux dialyzers (p < 0.05 for all). Last session levels of interleukin-6, interleukin-10, interleukin-17, and interferon-gamma did not differ between dialyzers (p > 0.05 for all). VEGF level was lower in the MCO group compared to the high-flux group (p = 0.043). Last session level of serum albumin with MCO dialyzers was lower than that with high-flux dialyzers (3.62 [3.45–3.88] vs. 3.78 [3.58–4.02] g/L) (p = 0.04) and 6.7% lower (p < 0.001) than at the first session of MCO dialyzers. Conclusion: The decline in circulating levels of several middle and large uremic toxins including VEGF following hemodialysis was more pronounced when using MCO membranes as compared to high-flux membranes while their effect on inflammatory molecules was similar.

1.
GBD Chronic Kidney Disease Collaboration
.
Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
.
Lancet
.
2020
;
395
(
10225
):
709
33
.
2.
Liyanage
T
,
Ninomiya
T
,
Jha
V
,
Neal
B
,
Patrice
HM
,
Okpechi
I
, et al
Worldwide access to treatment for end-stage kidney disease: a systematic review
.
Lancet
.
2015
;
385
(
9981
):
1975
82
.
3.
Canaud
B
,
Köhler
K
,
Sichart
J
,
Möller
S
.
Global prevalent use, trends and practices in haemodiafiltration
.
Nephrol Dial Transplant
.
2020
;
35
(
3
):
398
407
.
4.
Saran
R
,
Robinson
B
,
Abbott
KC
,
Agodoa
LY
,
Albertus
P
,
Ayanian
J
, et al
US renal data system 2016 annual data report: epidemiology of kidney disease in the United States
.
Am J Kidney Dis
.
2019
;
69
(
3 Suppl 1
):
A7
.
5.
Yeun
JY
,
Levine
RA
,
Mantadilok
V
,
Kaysen
GA
.
C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients
.
Am J Kidney Dis
.
2000
;
35
(
3
):
469
76
.
6.
Vanholder
R
,
De
Smet
R
,
Glorieux
G
,
Argilés
A
,
Baurmeister
U
,
Brunet
P
, et al
Review on uremic toxins: classification, concentration, and interindividual variability
.
Kidney Int
.
2003
;
63
(
5
):
1934
43
.
7.
Desjardins
L
,
Liabeuf
S
,
Lenglet
A
,
Lemke
HD
,
Vanholder
R
,
Choukroun
G
, et al
Association between free light chain levels, and disease progression and mortality in chronic kidney disease
.
Toxins
.
2013
;
5
(
11
):
2058
73
.
8.
Ronco
C
,
La Manna
G
.
Expanded hemodialysis: a new therapy for a new class of membranes
.
Contrib Nephrol
.
2017
;
190
:
124
33
.
9.
Wolley
MJ
,
Hutchison
CA
.
Large uremic toxins: an unsolved problem in end-stage kidney disease
.
Nephrol Dial Transplant
.
2018
;
33
(
Suppl l–3
):
iii6
iii11
.
10.
Cobo
G
,
Lindholm
B
,
Stenvinkel
P
.
Chronic inflammation in end-stage renal disease and dialysis
.
Nephrol Dial Transplant
.
2018
;
33
(
Suppl l–3
):
iii35
40
.
11.
Belmouaz
M
,
Bauwens
M
,
Hauet
T
,
Bossard
V
,
Jamet
P
,
Joly
F
, et al
Comparison of the removal of uraemic toxins with medium cut-off and high-flux dialysers: a randomized clinical trial
.
Nephrol Dial Transplant
.
2020
;
35
(
2
):
328
35
.
12.
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
;
89
(
1
):
50
6
.
13.
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
;
11
(
5
):
742
6
.
14.
Kirsch
AH
,
Rosenkranz
AR
,
Lyko
R
,
Krieter
DH
.
Effects of hemodialysis therapy using dialyzers with medium cut-off membranes on middle molecules
.
Contrib Nephrol
.
2017
;
191
:
158
67
.
15.
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
31
.
16.
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
;
32
(
1
):
165
72
.
17.
Maduell
F
,
Rodas
L
,
Broseta
JJ
,
Gomez
M
,
Xipell
M
,
Guillen
E
, et al
Medium cut-off dialyzer versus eight hemodiafiltration dialyzers: comparison using a global removal score
.
Blood Purif
.
2019
;
48
(
2
):
167
74
.
18.
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
;
12
(
1
):
e0169024
.
19.
Yuan
J
,
Guo
Q
,
Qureshi
AR
,
Anderstam
B
,
Eriksson
M
,
Heimbürger
O
, et al
Circulating vascular endothelial growth factor (VEGF) and its soluble receptor 1 (sVEGFR-1) are associated with inflammation and mortality in incident dialysis patients
.
Nephrol Dial Transplant
.
2013
;
28
(
9
):
2356
63
.
20.
Daugirdas
JT
.
Simplified equations for monitoring Kt/V, PCRn, eKt/V, and ePCRn
.
Adv Ren Replace Ther
.
1995
;
2
(
4
):
295
304
.
21.
Bergström
J
,
Wehle
B
.
No change in corrected beta 2-microglobulin concentration after cuprophane haemodialysis
.
Lancet
.
1987
;
1
(
8533
):
628
9
.
22.
Ronco
C
.
The rise of expanded hemodialysis
.
Blood Purif
.
2017
;
44
(
2
):
I
VIII
.
23.
Wolley
M
,
Jardine
M
,
Hutchison
CA
.
Exploring the clinical relevance of providing increased removal of large middle molecules
.
Clin J Am Soc Nephrol
.
2018
;
13
(
5
):
805
14
.
24.
Mallamaci
F
,
Benedetto
FA
,
Tripepi
G
,
Cutrupi
S
,
Pizzini
P
,
Stancanelli
B
, et al
Vascular endothelial growth factor, left ventricular dysfunction and mortality in hemodialysis patients
.
J Hypertens
.
2008
;
26
(
9
):
1875
82
.
25.
van Gelder
MK
,
Abrahams
AC
,
Joles
JA
,
Kaysen
GA
,
Gerritsen
KGF
.
Albumin handling in different hemodialysis modalities
.
Nephrol Dial Transplant
.
2018
;
33
(
6
):
906
13
.
26.
Ward
RA
,
Beck
W
,
Bernardo
AA
,
Alves
FC
,
Stenvinkel
P
,
Lindholm
B
.
Hypoalbuminemia: a price worth paying for improved dialytic removal of middle-molecular-weight uremic toxins?
Nephrol Dial Transplant
.
2019
;
34
(
6
):
901
7
.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.