TY  - JOUR
A1  - Krieter, Detlef H.
A1  - Rüth, Marieke
A1  - Lemke, Horst-Dieter
A1  - Wanner, Christoph
T1  - Clinical performance comparison of two medium cut-off dialyzers
JF  - Therapeutic Apheresis and Dialysis
N2  - Introduction
Medium-cut-off (MCO) dialyzers may beneficially impact outcomes in patients on hemodialysis.
Methods
In a randomized, controlled trial in maintenance hemodialysis patients, the new Nipro ELISIO-17HX MCO dialyzer was compared to the Baxter Theranova 400 filter regarding middle molecule removal. Furthermore, the suitability of two assays for free lambda-light chain (λFLC) detection (Freelite vs. N-Latex) was verified.
Results
ELISIO-HX achieved slightly lower reduction ratios for β2-microglobulin (71.8 ± 6.0 vs. 75.3 ± 5.8%; p = 0.001), myoglobin (54.7 ± 8.6 vs. 64.9 ± 8.7%; p < 0.001), and kappa-FLC (62.1 ± 8.8 vs. 56.3 ± 7.7%; p = 0.021). λFLC reduction ratios were more conclusive with the Freelite assay and not different between ELISIO-HX and Theranova (28.4 ± 3.9 vs. 38.7 ± 13.4%; p = 0.069). The albumin loss of Theranova was considerably higher (2.14 ± 0.45 vs. 0.77 ± 0.25 g; p = 0.001) and the Global Removal ScoreLoss alb largely inferior (30.6 ± 7.4 vs. 82.4 ± 29.2%/g; p = 0.006) to ELISIO-HX.
Conclusions
The new ELISIO-HX expands the choice of dialyzers for MCO hemodialysis.
KW  - dialysis adequacy
KW  - medium cut-off dialyzer
KW  - hemodialysis
KW  - free light chains
KW  - end-stage kidney disease
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318643
VL  - 27
IS  - 2
SP  - 284
EP  - 292
ER  - 
TY  - JOUR
A1  - Krieter, Detlef H.
A1  - Kerwagen, Simon
A1  - Rüth, Marieke
A1  - Lemke, Horst-Dieter
A1  - Wanner, Christoph
T1  - Differences in dialysis efficacy have limited effects on protein-bound uremic toxins plasma levels over time
JF  - Toxins
N2  - The protein-bound uremic toxins para-cresyl sulfate (pCS) and indoxyl sulfate (IS) are associated with cardiovascular disease in chronic renal failure, but the effect of different dialysis procedures on their plasma levels over time is poorly studied. The present prospective, randomized, cross-over trial tested dialysis efficacy and monitored pre-treatment pCS and IS concentrations in 15 patients on low-flux and high-flux hemodialysis and high-convective volume postdilution hemodiafiltration over six weeks each. Although hemodiafiltration achieved by far the highest toxin removal, only the mean total IS level was decreased at week three (16.6 ± 12.1 mg/L) compared to baseline (18.9 ± 13.0 mg/L, p = 0.027) and to low-flux dialysis (20.0 ± 12.7 mg/L, p = 0.021). At week six, the total IS concentration in hemodiafiltration reached the initial values again. Concentrations of free IS and free and total pCS remained unaltered. Highest beta2-microglobulin elimination in hemodiafiltration (p < 0.001) led to a persistent decrease of the plasma levels at week three and six (each p < 0.001). In contrast, absent removal in low-flux dialysis resulted in rising beta2-microglobulin concentrations (p < 0.001). In conclusion, this trial demonstrated that even large differences in instantaneous protein-bound toxin removal by current extracorporeal dialysis techniques may have only limited impact on IS and pCS plasma levels in the longer term.
KW  - protein-bound uremic toxins
KW  - end-stage renal disease
KW  - hemodialysis
KW  - hemodiafiltration
KW  - dialysis adequacy
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201770
VL  - 11
IS  - 4
ER  -