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Abstract: PO1063

Medium Cut-Off Dialyzer Improves Erythropoiesis-Stimulating Agent Resistance in a Hepcidin-Independent Manner in Maintenance Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lim, Jeong-Hoon, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Kim, Yong-Jin, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Jung, Hee-Yeon, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Choi, Ji-Young, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Park, Sun-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Kim, Chan-Duck, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Kim, Yong-Lim, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
Background

The response to erythropoiesis stimulating agents (ESAs) is affected by inflammation linked to middle molecules in hemodialysis (HD) patients. We evaluated the effect of a medium cut-off (MCO) dialyzer on ESA resistance in maintenance HD patients.

Methods

Forty-nine patients who underwent high-flux HD were randomly allocated to the MCO or high-flux group. The primary outcome was the changes of erythropoietin resistance index (ERI; U/kg/wk/g/dL) between baseline and 12 weeks. The biomarkers associated with iron metabolism and inflammation at 12 weeks were compared between groups.

Results

The MCO group showed significant decrease in the ESA dose, weight-adjusted ESA dose, and ERI compared to the high-flux group at 12 weeks (all p < 0.05). In the MCO group, the ESA dose, weight-adjusted ESA dose, and ERI did not change until 8 weeks compared to those at baseline, but decreased significantly at 12 weeks (all p < 0.01). Serum iron and transferrin saturation were higher in the MCO group at 12 weeks (both p < 0.05). The MCO group showed a greater reduction in TNF-α and lower serum TNF-α level at 12 weeks compared to the high-flux group (p = 0.025 and p = 0.027), whereas no differences were found in the reduction ratio of hepcidin and serum levels of erythropoietin, erythroferrone, soluble transferrin receptor and hepcidin between groups.

Conclusion

HD with MCO dialyzer improves ESA resistance compared to high-flux HD in maintenance HD patients. The MCO dialyzer provides superior removal of the inflammatory cytokine such as TNF-α and thus improves iron metabolism in a hepcidin-independent manner.

The iron metabolism regulatory pathway
Blue arrows indicate dominant effects.