Abstract: SA-PO760

UK Clinical Experiences of a New Expanded Hemodialysis Therapy with a Novel Medium Cut-Off Dialyzer

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Baharani, Jyoti B., Heart of England NHS Foundation Trust, Birmingham, United Kingdom
  • Barrios, Bernard, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
  • Hopkins, Debbie, Morriston Hospital, Swansea, United Kingdom
  • Passmore, Wyn, Morriston Hospital, Swansea, United Kingdom
Background

Middle molecules are associated with the pathology of uremia, and their removal is enhanced by increased convection with hemodiafiltration (HDF) therapy. However, HDF therapy may not be suitable for, or available to, all patients. A newly developed medium cut-off (MCO) membrane allows hemodialysis (HD) to be expanded in terms of middle molecule removal (HDx therapy) using conventional HD infrastructure. Here, we describe the experience of two UK clinics trialing HDx therapy.

Methods

At Heartlands Hospital (HH), the patient demographic (n=8) was: 48–90 years of age, mixed ethnicities, and 1–14 years of HD experience. Patients (treated thrice weekly) were switched from high-flux HD with a polysulfone dialyzer (FX60 or FX80, Fresenius) to HDx therapy with the MCO membrane (Theranova 400, Baxter). At Morriston Hospital (MH), patients (n=18) were 25–91 years of age with 2–16 years of HD experience. Patients who had failed to tolerate (n=14) or tolerated (n=4) HDF therapy were switched to HDx therapy with the MCO membrane.

Reduction ratios (RRs) of beta-2-microglobulin (β2M) and albumin loss were assessed; data are based on averages of 3 dialysis sessions (HH) or 1 dialysis session (MH).

Results

At HH, average β2M RRs (post- vs pre-dialysis level) with HDx therapy were 69.3% (Week 1) and 69.4% (Week 9) vs 48.8% with high-flux HD. At Week 9, serum albumin levels increased during dialysis by 0.8 g/L. Following 9 weeks of HDx therapy, pre-dialysis levels of β2M were reduced by 11.7%, and no difference in albumin level was seen.

At MH, average β2M RRs with HDx therapy were 71.0% (Week 1) and 73.9% (Week 9). For patients who tolerated HDF, at Week 1 β2M RRs were 72.2% and 73.9% with HDx and HDF therapy, respectively. Based on serum albumin levels, albumin loss in both groups was minimal.a No adverse events were noted; 1 patient with arthritis did not experience any arthritic flare-ups during HDx therapy.

Conclusion

HDx therapy was convenient, simple to implement, and achieved high β2M RRs with low albumin loss. It offers opportunity for achieving the clearance of middle molecules delivered by HDF, when patient factors exist or HDF is not available.

aBased on 2 of 4 HDF patients and all 14 HDx patients.