title: Performance of hemodialysis with novel medium cut-off dialyzers.
abstract: Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules.
  
  
  
  In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF). Primary outcome was lambda free light chain (λFLC) overall clearance. Secondary outcomes included overall clearances and pre-to-post-reduction ratios of middle and small molecules, and safety of MCO HD treatments.
  
  
  
  MCO HD provided greater λFLC overall clearance [least square mean (standard error)] as follows: study 1: MCO AA 8.5 (0.54), MCO BB 11.3 (0.51), MCO CC 15.0 (0.53) versus high-flux HD 3.6 (0.51) mL/min; study 2: MCO AA 10.0 (0.58), MCO BB 12.5 (0.57) versus high-flux HD 4.4 (0.57) and HDF 6.2 (0.58) mL/min. Differences between MCO and high-flux dialyzers were consistently significant in mixed model analysis (each P < 0.001). Reduction ratios of λFLC were greater for MCO. Clearances of α1-microglobulin, complement factor D, kappa FLC (κFLC) and myoglobin were generally greater with MCO than with high-flux HD and similar to or greater than clearances with HDF. Albumin loss was moderate with MCO, but greater than with high-flux HD and HDF.
  
  
  
  MCO HD removes a wide range of middle molecules more effectively than high-flux HD and even exceeds the performance of high-volume HDF for large solutes, particularly λFLC.
authors: Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Alexander H
authors: AH
authors: Kirsch
authors: Division of Nephrology, Department of Medicine, University Hospital, Würzburg, Germany.
authors: Raphael
authors: R
authors: Lyko
authors: Gambro Lundia AB, Baxter Renal Therapeutic Area, Lund, Sweden.
authors: Lars-Göran
authors: LG
authors: Nilsson
authors: Gambro Dialysatoren GmbH, Baxter Renal Therapeutic Area, Hechingen, Germany.
authors: Werner
authors: W
authors: Beck
authors: Baxter Healthcare Corporation, Life Science & Operations, Round Lake, IL, USA.
authors: Michael
authors: M
authors: Amdahl
authors: Department of Internal Medicine, LKH Hochsteiermark, Bruck, Austria.
authors: Petra
authors: P
authors: Lechner
authors: Division of Nephrology, Department of Medicine, University Hospital, Würzburg, Germany.
authors: Andreas
authors: A
authors: Schneider
authors: Division of Nephrology, Department of Medicine, University Hospital, Würzburg, Germany.
authors: Christoph
authors: C
authors: Wanner
authors: Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Alexander R
authors: AR
authors: Rosenkranz
authors: Division of Nephrology, Department of Medicine, University Hospital, Würzburg, Germany.
authors: Detlef H
authors: DH
authors: Krieter
mesh_terms: D000368:Aged; D000418:Albumins / Q000032:analysis; D000510:Alpha-Globulins / Q000032:analysis; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007146:Immunoglobulin lambda-Chains / Q000032:analysis; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010539:Permeability; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D000418:Albumins; D000510:Alpha-Globulins; D007146:Immunoglobulin lambda-Chains; D008567:Membranes, Artificial; C016001:alpha-1-microglobulin
keywords: beta2-microglobulin; dialysis; hemodiafiltration; hemodialysis; uremic toxins