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Kidney Week

Abstract: FR-PO464

Removal of Middle Molecules Using Medium Cut-Off Membranes in Hemodialysis Mode vs. High-Flux Membranes in Post-Dilutional Online Hemodiafiltration Mode: The REMOC Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Kirsch, Alexander H., Medical University of Graz, Graz, Austria
  • Komericki-Strimitzer, Tanja, Austrian Agency for Health and Food Safety, Graz, Austria
  • Rosenkranz, Alexander R., Medical University of Graz, Graz, Austria

Medium-cut off (MCO) dialyzers were shown to provide better clearance of larger middle molecules compared to high-flux HD and hemodiafiltration (HDF). Whether this results in lower predialysis levels in decreased exposure is not clear.


In this randomized, open-label, cross over study, 27 HD patients were randomized to either 12 weeks of HD with MCO dialyzers (Theranova 400, Baxter) or online post-dilution HDF with high-flux dialyzers (FxCorDiax 800, Fresenius medical care) using maximally achievable substitution volumes. After 12 weeks, patients were crossed-over to the other treatment modality for 12 weeks. Pre-dialysis serum levels of middle molecules (λ- and κ-free light chains [FLC] were assessed at the beginning and end of each treatment period. The primary outcome was efficiency as assessed by predialysis treatment levels of λ- and κ-FLC, as well as safety (serum albumin levels and frequency of adverse events).
A mixed linear model based on the delta value to baseline was used to compare the effect of MCO-HD and HDF on FLC levels. Here, treatment modality and randomization order were assumed as fixed effects, the patient as random effect.


Twenty-seven patients were randomized, six dropped out doe to unability to receive randomized study treatment. Twenty-one patients completed the study and were included in the analysis (14 [66.7%] males; mean age 56.9±14.9 years; mean BMI 28.2±7.4; median dialysis vintage 16 [8-40] months).
For κ- and λ-FLC, the delta to baseline after 12 weeks of MCO-HD compared to HDF (κ: -0.8±52.3 vs. -8.0±61.0 mg/dL; λ-FLC: 4.2±24.1 vs. -4.2±26.6 mg/dL) was not significantly influenced by treatment modality or order (κ-FLC: p=0.29; λ: p=0.37) but rather by the patient (κ-FLC: p=0.004; λ-FLC: p=0.02). There was no difference in AE incidence or delta serum albumin levels (MCO-HD vs. HDF: 0.0±0.2 vs 0.0±0.3 g/dL) between treatment modalities.


Twelve weeks of MCO-HD treatment compared to twelve weeks of HDF did not signifantly change pre-dialysis levels of κ- and λ-FLC in prevalent dialysis patients. This suggests that MCO-HD clears larger middle molecules as effectively as high-efficiency HDF, which may allow to extend the benefits of HDF to patients and areas where this treament modality is not available.