title: Elimination of large uremic toxins by a dialyzer specifically designed for high-volume convective therapies.
abstract: BACKGROUND
  Unlike conventional hemodialysis treatments, which rely almost solely on diffusion-related mechanisms for solute removal, hemodiafiltration (HDF) allows more efficient removal of higher molecular weight toxins due to convective transport mechanisms. To facilitate the removal of these toxins in HDF treatment modalities, dialyzers with highly efficient high-flux membranes are necessary. This study assessed the large uremic toxin removal ability of a high-flux dialyzer (FX CorDiax 60) specifically designed to facilitate convective therapies compared with a standard high-flux dialyzer (FX 60).
  
  
  METHODS
  In an open, randomized, cross-over, single-center, controlled, prospective clinical study, 30 adult chronic hemodialysis patients were treated by post-dilution online HDF with the FX 60 or the FX CorDiax 60 dialyzer. All other dialysis parameters were kept constant in both study arms. The reduction rate (RR) of blood urea nitrogen, phosphate, β2-microglobulin (β2-m), myoglobin, prolactin, α1-microglobulin, α1-acid glycoprotein, albumin and total protein as well as the elimination into dialysate was intraindividually compared for the two dialyzer types.
  
  
  RESULTS
  For FX CorDiax 60 versus FX 60, the RR was significantly higher for blood urea nitrogen (86.23 ± 4.14 vs. 84.89 ± 4.59%, p = 0.015), β2-m (84.67 ± 3.79 vs. 81.30 ± 4.82%, p < 0.0001), myoglobin (75.23 ± 10.48 vs. 58.60 ± 12.1%, p < 0.0001), prolactin (72.96 ± 9.68 vs. 56.91 ± 13.01%, p < 0.0001) and α1-microglobulin (20.89 ± 18.27 vs. 13.60 ± 12.50%, p = 0.016). There were no significant differences in the RR for phosphate, α1-acid glycoprotein, albumin and total protein. Mass removal was significantly higher with the FX CorDiax 60 than with the FX 60 for β2-m (0.26 ± 0.09 vs. 0.24 ± 0.09 g, p = 0.0006), myoglobin (1.83 ± 0.89 vs. 1.51 ± 0.76 mg, p = 0.0017), prolactin (0.17 ± 0.13 vs. 0.14 ± 0.08 mg, p = 0.02) and albumin (4.25 ± 3.49 vs. 3.01 ± 2.37 g, p = 0.03).
  
  
  CONCLUSIONS
  This study demonstrates that treating patients with an FX CorDiax 60 instead of an FX 60 dialyzer in post-dilution HDF mode significantly increases the elimination of middle molecules.
authors.affiliation: Departments of Nephrology and Renal Transplantation, Hospital Clínic Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Maduell
authors.forename: M
authors.initials: M
authors.lastname: Arias-Guillen
authors.forename: N
authors.initials: N
authors.lastname: Fontseré
authors.forename: R
authors.initials: R
authors.lastname: Ojeda
authors.forename: N
authors.initials: N
authors.lastname: Rico
authors.forename: M
authors.initials: M
authors.lastname: Vera
authors.forename: M
authors.initials: M
authors.lastname: Elena
authors.forename: J L
authors.initials: JL
authors.lastname: Bedini
authors.forename: P
authors.initials: P
authors.lastname: Wieneke
authors.forename: J M
authors.initials: JM
authors.lastname: Campistol
mesh_terms: D000368:Aged; D000418:Albumins; D000510:Alpha-Globulins; D001806:Blood Urea Nitrogen; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D000418:Albumins; D000510:Alpha-Globulins; D010710:Phosphates; C016001:alpha-1-microglobulin; D001613:beta 2-Microglobulin