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Abstract: SA-PO409

Comparison of High-Flux, Super High-Flux, Medium Cut-Off Hemodialysis and Online Hemodiafiltration on the Removal of Uremic Toxins

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Belmouaz, Mohamed, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
  • Goussard, Guillaume, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
  • Joly, Florent, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
  • Thomas, Betous, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
  • Bridoux, Frank, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France

Middle molecules (MM) that are inadequately removed by high-flux (HF) hemodialysis (HD) strategies are thought to contribute to the high morbidity and mortality of HD patients. On-line hemodiafiltration (OL-HDF) and HD using high-performance membranes such as adsorptive, medium cut-off (MCO), super high-flux (SHF) or protein permeable dialyzers have been implemented to enhance the removal of MM. The aim of this study was to compare the efficacy of these dialyzers used under different dialysis strategies on small solutes and MM reduction ratio (RR) and mass removal.


We performed a prospective study in 8 HD patients. Each patient underwent 9 dialysis sessions: seven sessions on HD using either Theranova 500™, Elisio 21H™, Renak PS-2.0W™, Filtryzer BK-2.1F™, Vie 21X™, TS-2.1UL™ or FDY 210-GW™ dialyzers and two sessions on OL-HDF using Elisio 21H™ or Renak PS-2.0W™ dialyzers.


Urea mass removal and RR were similar between all dialysis strategies. The lowest beta2-microglobulin RR was achieved with Filtryzer BK-2.1F™ HD (p<0.05). Compared to Elisio 21H™ HD, Renak PS-2.0W™ OL-HDF produced higher beta2-microglobulin mass removal (181±46 vs 317±161 mg, p<0.05). Theranova 500™ HD, Vie 21X™ HD, FDY 210-GW™ HD, Elisio 21H™ OL-HDF and Renak PS-2.0W™ OL-HDF induced higher RR for kappa and lambda FLC, as compared to Elisio 21H™ HD and Filtryzer BK-2.1F™ HD (p<0.05). TS-2.1UL™ HD and Renak PS-2.0W™ HD produced higher lambda FLC RR compared to Elisio 21H™ HD (p<0.05). Renak PS-2.0W™ OL-HDF achieved higher kappa FLC mass removal compared to Elisio 21H™ HD (563±515 vs 141±47 mg, p<0.01) and to Renak PS-2.0W™ HD (563±515 vs 153±25 mg, p<0.05). Albumin loss varied from 0.02±0.05 to 7.6±3.8 g/session with Elisio 21H™ HD and Renak PS-2.0W™ OL-HDF, respectively. Compared to all other strategies, Renak PS-2.0W™ OL-HDF induced a significantly higher albumin loss (p<0.05).


This study confirms that albumin loss and the removal of MM, are similar using conventional Elisio 21H™ OL-HDF, MCO-HD (Theranova 500) and SHF type V dialyzers (Vie 21X and FDY 210-GW). Although Renak PS-2.0W™ OL-HDF provides high performance for MM depuration, this protein-permeable dialyzer should not be used in post-dilution OL-HDF because of albumin loss exceeding the theoretical acceptable limit of 5 g per session.