Disruptive technologies for hemodialysis: medium and high cutoff membranes. Is the future now?

Abstract In the past decade, a new class of hemodialysis (HD) membranes (high retention onset class) became available for clinical use. The high cutoff (HCO) and the medium cutoff (MCO) membranes have wider pores and more uniformity in pore size, allowing an increased clearance of uremic toxins. Owing to the mechanism of backfiltration/internal filtration, middle molecules are dragged by the convective forces, and no substitution solution is needed. The HCO dialyzer is applied in septic patients with acute kidney injury requiring continuous kidney replacement therapy. The immune response is modulated thanks to the removal of inflammatory mediators. Another current application for the HCO dialyzer is in hematology, for patients on HD secondary to myeloma-kidney, since free light chains are more efficiently removed with the HCO membrane, reducing their deleterious effect on the renal tubules. In its turn, the MCO dialyzer is used for maintenance HD patients. A myriad of clinical trials published in the last three years consistently demonstrates the ability of this membrane to remove uremic toxins more efficiently than the high-flux membrane, an evolutionary disruption in the HD standard of care. Safety concerns regarding albumin loss as well as blood contamination from pyrogens in the dialysate have been overcome. In this update article, we explore the rise of new dialysis membranes in the light of the scientific evidence that supports their use in clinical practice.</div

MOESM1 of Polymyxin-B hemoperfusion in septic patients: analysis of a multicenter registry

Additional file 1. Supplementary Material

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Additional file 4: Figure S3. Kaplan-Meier plot for European “responders/non-responders”

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Additional file 3: Figure S2. Kaplan-Meier European patients versus Asian patients

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Additional file 2: Figure S1. Kaplan-Meier cardiovascular responders vs cardiovascular non responders

Values of time and frequency domain indices estimated during the first 15 min (baseline) and the last 30 min of the HD session.

<p>Patients are grouped in tertiles of pre-dialysis FO/ECW%. Diabetic patients are excluded.</p><p>Comparisons between baseline (BL) and last 30 min of hemodialysis (HD)</p><p># Wilcoxon signed rank test p-value< 0.05, or</p><p>§ p-value<0.01 (italics)</p><p>Values of time and frequency domain indices estimated during the first 15 min (baseline) and the last 30 min of the HD session.</p

Additional file 1: of Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review

Results According to RRT Modality. (PDF 131 kb

Hematocrit values.

<p>Boxplot of patient hematocrit values at the start and end of hemodialysis grouped by pre-dialysis FO/ECW% tertiles. HD: hemodialysis. BVM: Blood Volume Monitor device.</p

Values of time and frequency domain indices estimated during the first 15 min (baseline) and last 30 min of the HD session.

<p>Patients are grouped in tertiles of pre-dialysis FO/ECW%.</p><p>Comparisons between baseline (BL) and last 30 min of hemodialysis (HD)</p><p># Wilcoxon signed rank test p-value< 0.05, or</p><p>§ p-value<0.01 (italics)</p><p>*Kruskal–Wallis one-way analysis of variance p<0.05, post hoc comparison p-value <0.05 vs 1st tertile</p><p>°Kruskal–Wallis one-way analysis of variance p<0.05, post hoc comparison p-value <0.05 vs 2nd tertile</p><p>The bold values mark the indices, which significantly differ among groups.</p><p>Values of time and frequency domain indices estimated during the first 15 min (baseline) and last 30 min of the HD session.</p

Data of analyzed patients.

<p>Values are expressed as median (25°,75° percentile) and the occurence of comorbidities and drug prescription are reported</p><p>* one-way ANOVA p<0.05, post hoc comparison p-value <0.05 vs 1^st tertile and 2^nd tertile</p><p>§ kruskall wallis ANOVA p<0.05, post hoc comparison p-value <0.05 vs 2^nd tertile.</p><p>SBP = systolic blood pressure; DBP = diastolic blood pressure.</p><p>Data of analyzed patients.</p