ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO348

Comparison of the Removal of Uremic Toxins with Medium Cut-Off and High-Flux Dialyzers: A Randomized Clinical Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Belmouaz, Mohamed, CHU POITIERS, Poitiers, France
  • Bauwens, Marc, CHU POITIERS, Poitiers, France
  • Bouteau, Iseline, CHU POITIERS, Poitiers, France
  • Thierry, Antoine, CHU POITIERS, Poitiers, France
  • Ecotiere, Laure, CHU POITIERS, Poitiers, France
  • Bridoux, Frank, CHU POITIERS, Poitiers, France

Accumulation of middle weight toxins (500 Da-60 kDa) in hemodialysis (HD) patients results in increased morbidity and mortality. Conventional high-flux (HF) dialyzers allow efficient removal of beta2 microglobulin (11.8 kDa), but their effect on higher molecular weight molecules is not well established. Whether new generation of medium cut-off (MCO) dialyzer improve removal of middle to high molecular weight uremic toxins remains to be demonstrated.


Theranova, a randomized, open-label, cross-over study (NCT03211676) was designed to compare MCO-HD to HF-HD on the epuration of middle weight uremic toxins. Forty six patients treated with HF dialyzer Elisio 21H™ for more than 6 months were randomized to either continue on this membrane (n=22) or to receive the Theranova 500™ dialyzer (n=24). After 3 months, patients crossed over to the other dialyzer during 3 other months.
Primary outcome was myoglobin (17 kDa) reduction ratio (RR) at 3 months. Secondary outcomes were RR, pre and post dialysis levels of beta2 microglobulin, prolactin, hepcidin, leptin, retinol binding protein, alpha 1 glycoprotein, fibroblast growth factor-23, hyaluronic acid, homocystein and cytokines (IL6, IL1-beta, TNF-alpha) at 3 and 6 months.
Nutritional and inflammatory parameters, level of albumin and oxidative stress mediators (8-iso-Prostaglandin, oxidized LDL, superoxide dismutase), anemia parameters and erythropoietin resistance index were also determined.


Forty patients completed the study. Mean age was 76 ± 9 years (male gender 74%). MCO-HD provides higher median RR of myoglobin [59% vs 36%, p<0.0001] whereas beta2 microglobulin RR was similar [77% vs 69%, p=0.7], as compared to HF-HD.
Mean pre-dialysis beta2 microglobulin levels [26.9 mg/l vs 28.4 mg/l, p =0.001] and post dialysis myoglobin levels [76 μg/l vs 126 μg/l, p<0.0001] were significantly lower with MCO-HD. Pre and post dialysis albumin levels were significantly lower with MCO-HD [36.9 g/l vs 38.2 g/l, p=0.004] and [40 g/l vs 42.3 g/l, p=0.004].


These preliminary data indicate that MCO-HD provides significant removal of myoglobin and decrease in beta2 microglobulin pre dialysis level, with higher albumin loss than HF-HD. Complete results will be presented during the meeting.


  • Commercial Support