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Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study.
Blood Purif. 2020; 49(6):733-742.BP

Abstract

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.

Authors+Show Affiliations

Nephrology Department, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.Nephrology Department, Hakkari State Hospital, Hakkari, Turkey.Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.Nephrology Department, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey, tanerbast@yahoo.com.Nephrology Department, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.Nephrology Department, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.Nephrology Department, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.Nephrology Department, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32634815

Citation

Sevinc, Mustafa, et al. "Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated With Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study." Blood Purification, vol. 49, no. 6, 2020, pp. 733-742.
Sevinc M, Hasbal NB, Yilmaz V, et al. Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study. Blood Purif. 2020;49(6):733-742.
Sevinc, M., Hasbal, N. B., Yilmaz, V., Basturk, T., Ahbap, E., Sakaci, T., Ozcafer, P. N., & Unsal, A. (2020). Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study. Blood Purification, 49(6), 733-742. https://doi.org/10.1159/000508061
Sevinc M, et al. Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated With Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study. Blood Purif. 2020;49(6):733-742. PubMed PMID: 32634815.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study. AU - Sevinc,Mustafa, AU - Hasbal,Nuri Baris, AU - Yilmaz,Vuslat, AU - Basturk,Taner, AU - Ahbap,Elbis, AU - Sakaci,Tamer, AU - Ozcafer,Perin Nazif, AU - Unsal,Abdulkadir, Y1 - 2020/07/07/ PY - 2020/03/06/received PY - 2020/04/20/accepted PY - 2020/7/8/pubmed PY - 2021/6/5/medline PY - 2020/7/8/entrez KW - Dialysis membrane KW - Inflammation KW - Medium cut-off KW - Uremic toxins KW - Vascular endothelial growth factor SP - 733 EP - 742 JF - Blood purification JO - Blood Purif VL - 49 IS - 6 N2 - 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. SN - 1421-9735 UR - https://www.unboundmedicine.com/medline/citation/32634815/Comparison_of_Circulating_Levels_of_Uremic_Toxins_in_Hemodialysis_Patients_Treated_with_Medium_Cut_Off_Membranes_and_High_Flux_Membranes:_Theranova_in_Sisli_Hamidiye_Etfal__THE_SHE__Randomized_Control_Study_ DB - PRIME DP - Unbound Medicine ER -