title: Effect of a More Permeable Dialysis Membrane on ESA Resistance in Hemodialysis Patients--A Pilot Investigation.
abstract: OBJECTIVE
  Hemodialysis (HD) patients often show impaired response to erythropoiesis-stimulating agents (ESAs). Extended HD membrane permeability may potentially improve ESA response.
  
  
  METHODS
  Twenty-four prevalent HD patients were randomly assigned to 12 weeks use of high cut-off (HCO) membrane (in every second dialysis treatment) or continued treatment with high-flux membrane. We monitored changes in hemoglobin (Hb), ESA dose, and key biochemical markers.
  
  
  RESULTS
  The Hb level increased in the study group (from 11.6 ± 1.0 to 12.5 ± 1.5 g/dl; p = 0.038) but was stable in the control group. Variation over time in ESA dose and ESA resistance index did not differ between groups. HCO membrane usage for 12 weeks led to decreased hepcidin level, from 303 ± 189 to 157 ± 83 ng/ml (p = 0.024); serum albumin level decreased and stabilized 15 ± 6% below baseline.
  
  
  CONCLUSIONS
  These results indicate that use of a more permeable dialysis membrane may improve ESA responsiveness in iron-replete HD patients. Extensive albumin removal may preclude long-term use of the HCO membrane.
authors.affiliation: Department of Nephrology and Dialysis, Bollate Hospital, AO Garbagnate M.se, Milan, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Teatini
authors.forename: Ariane
authors.initials: A
authors.lastname: Liebchen
authors.forename: Lars-Göran
authors.initials: LG
authors.lastname: Nilsson
authors.forename: Werner
authors.initials: W
authors.lastname: Beck
authors.forename: Giorgio Romei
authors.initials: GR
authors.lastname: Longhena
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D004351:Drug Resistance; D000068817:Epoetin Alfa / Q000627:therapeutic use*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D064451:Hepcidins / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010539:Permeability; D010865:Pilot Projects; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis / Q000295:instrumentation*; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D064451:Hepcidins; C508600:IL6 protein, human; D015850:Interleukin-6; D008567:Membranes, Artificial; D011994:Recombinant Proteins; D012709:Serum Albumin; C103998:epoetin beta; D004921:Erythropoietin; D000068817:Epoetin Alfa; D002097:C-Reactive Protein