ackground High-flux hemodialysis has been widely used and has the advantages of improved clearance of uremic toxins and efficient removal of extra body fluid due to the hollow fiber membranes with a high ultrafiltration coefficient. Objective The present paper aims to investigate the clinical performance of two high-flux dialyzers, one equipped with polysulfone membranes (HF15 from Weigo), and the other equipped with cellulose triacetate membranes (FB-150U, short for 150U, from Nipro). Clearance efficiency of uremic toxins and the biocompatibility in a single hemodialysis session were compared between the two types of high-flux dialyzers. Methods A total of 20 patients treated with maintenance hemodialysis for more than 3 months were recruited from Weigao Blood Purification Center and were divided into two groups, HF15 Group (n=10) and 150U Group (n=10). Blood samples were collected right before the dialysis treatment, 15min and 60min during the treatment, and right after the treatment. The reduction ratio and clearance rate of uremic toxins as well as changes of blood cells and complement factor (C3a) were compared between the two groups. Results Age, sex, body weight and dialysis age were similar between two groups. Before the dialysis session, baseline parameters including treatment blood flow, small and medium molecule toxins, blood cells and complement factors had no significant differences between the two groups (P≥0.05). After the high-flux hemodialysis treatment for 4 hours, the reduction ratios and clearance rates of small molecule toxins (blood urea nitrogen, creatinine and phosphorus) had no significant differences between the two groups (For reduction ratios: t=0.932, 1.799 and 0.878 respectively; P=0.379, 0.052 and 0.299 respectively. For clearance rates: t=-1.892, 1.500 and -2.211 respectively; P=0.091, 0.168 and 0.056 respectively); HF15 group had higher reduction ratio (t=7.821, P<0.001) and clearance rate (t=2.686, P=0.013) of the middle molecular toxin β2 microglobulin than 150U group. Variations of blood cells and C3a during the hemodialysis session had no statistical significances between two groups. Conclusions During a single high-flux hemodialysis session, HF15 group had higher clearance rates of uremic toxins than 150U group, with equal biocompatibility between the two groups.
[1]Twardowski ZJ.History of hemodialyzers’ designs[J].Hemodial Int, 2008, 12(2):173-210
[2]Cheung AK, Levin NW, Greene T, et al.Effects of High-Flux Hemodialysis on Clinical Outcomes: Results of the HEMO Study[J].J Am Soc Nephrol, 2003, 14(12):3251-3263
[3] Locatelli F, Pozzoni P, Manzoni C, Di Filippo S.High-flux hemodialysis and hemodiafiltration Impact on outcome[J]. Contrib Nephrol, 2002, 137:193-200
[4]Ronco C, Clark WR.Haemodialysis membranes[J].Nat Rev Nephrol, 2018, 14(6):394-410
[5] Sunohara T, Masuda T.Cellulose triacetate as a high performance membrane[J]. Contrib Nephrol, 2011, 173:156-163
[6]Krause B, Storr M, Ertl T, et al.Polymeric Membranes for Medical Applications[J].Chemie-Ingenieur-Technik, 2003, 75(11):1725-1732
[7]Kirsch AH, Lyko R, Nilsson LG, et al.Performance of hemodialysis with novel medium cut-off dialyzers[J].Nephrol Dial Transplant, 2017, 32(1):165-172
[8]Breitsameter G, Figueiredo AE, Kochhann DS.Calculation of Kt V in haemodialysis?: a comparison between the formulas[J].J Bras Nefrol, 2012, 34(1):22-26
[9]Clark WR, Hamburger RJ, Lysaght MJ.Effect of membrane composition and structure on solute removal and biocompatibility in hemodialysis[J].Kidney Int, 1999, 56(6):2005-2015
[10]Masakane I, Sakurai K.Current approaches to middle molecule removal: room for innovation[J].Nephrol Dial Transplant, 2018, 33(Suppl 3):i-i
[11] Hedayat A, Szpunar J, Kumar NAPK, Peace R, Elmoselhi H, Shoker A.Morphological characterization of the Polyflux 210H hemodialysis filter pores[J].Int J Nephrol, 2012, :-
[12]Ronco C.The Rise of Expanded Hemodialysis[J].Blood Purif, 2017, 44(2):I-V
[13]Locatelli F, Mastrangelo F, Redaelli B, et al.Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters[J].Kidney Int, 1996, 50(4):1293-1302
[14]Westphalen H, Saadati S, Eduok U, et al.Case studies of clinical hemodialysis membranes: influences of membrane morphology and biocompatibility on uremic blood-membrane interactions and inflammatory biomarkers[J].Sci Rep, 2020, 10(1):1-18
[15]Locatelli F, Buoncristiani U, Canaud B, K?hler H, Petitclerc T, Zucchelli P.Dialysis dose and frequency[J].Nephrol Dial Transplant, 2005, 20(2):285-296
[16]Rocco M, Daugirdas JT, Depner TA, et al.KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update[J].Am J Kidney Dis, 2015, 66(5):884-930
[17]Kokubo K, Kurihara Y, Kobayashi K, Tsukao H, Kobayashi H.Evaluation of the Biocompatibility of Dialysis Membranes[J].Blood Purif, 2015, 40(4):293-297
[18]Maria Olszewska.The effect of hemodialysis on some parameters of the antioxidant system in the blood of patients with chronic renal failure[J].Ann Acad Med Stetin, 2005, 50(1):41-52
[19]Togo K, Yamamoto M, Imai M, Akiyama K, Yamashita AC.Comparison of biocompatibility in cellulose triacetate dialysis membranes with homogeneous and asymmetric structures[J].Ren Replace Ther, 2018, 4(1):1-5
[20] Liakopoulos V, Roumeliotis S, Gorny X, Dounousi E, Mertens PR.Oxidative Stress in Hemodialysis Patients: A Review of the Literature[J].Oxid Med Cell Longev, 2017, :-
[21]Itoh S, Susuki C, Tsuji T.Platelet activation through interaction with hemodialysis membranes induces neutrophils to produce reactive oxygen species[J].J Biomed Mater Res - Part A, 2006, 77(2):294-303
[22]De Sanctis LB, Stefoni S, Cianciolo G, et al.Effect of different dialysis membranes on platelet functionA tool for biocompatibility evaluation[J].Int J Artif Organs, 1996, 19(7):404-410
[23]M P Grooteman 1, M J Nubé, J van Limbeek, A J van Houte, M R Daha JA van G.Biocompatibility and performance of a modified cellulosic and a synthetic high flux dialyzerA randomized crossover comparison between cellulose triacetate and polysulphon[J].ASAIO J, 1995, 41(2):215-220
[24]Karaboyas A, Morgenstern H, Waechter S, et al.Low hemoglobin at hemodialysis initiation: an international study of anemia management and mortality in the early dialysis period[J].Clin, Kidney J, 2020, 13(3):425-433
[25]Locatelli F, Pisoni RL, Akizawa T, et al.Anemia management for hemodialysis patients: Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and Dialysis Outcomes and Practice Patterns Study (DOPPS) finding[J]s[J].Am J Kidney Dis, 2004, 44(SUPPL. 2):27-33
[26]Gao S, Cui Z, Zhao MH.The Complement C3a and C3a Receptor Pathway in Kidney Diseases[J].Front Immunol, 2020, 11(August):1-9
[27]Wagner S, Zsch?tzsch S, Erlenkoetter A, Rauber L, Stauss-Grabo M, Gauly A.Hemocompatibility of Polysulfone Hemodialyzers – Exploratory Studies on Impact of Treatment Modality and Dialyzer Characteristics[J].Kidney, 2020, 1(1):25-35