Journal ArticleDOI
A tRial Evaluating Mid Cut-Off Value Membrane Clearance of Albumin and Light Chains in HemoDialysis Patients: A Safety Device Study.
Rathika Krishnasamy,Carmel M. Hawley,Meg Jardine,Matthew A Roberts,Yeoungjee Cho,Muhgeot Wong,Anne Heath,Craig Nelson,Shaundeep Sen,Peter F Mount,Elaine M. Pascoe,Liza A. Vergara,Peta-Anne Paul-Brent,Nigel D Toussaint,David W. Johnson,Colin A. Hutchison +15 more
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Regular HD using the MCO dialyzer did not result in a significant fall in serum albumin and there was no improvement in restless legs symptoms, quality of life, 6MWT or MIS scores.Abstract:
Background: A new class of dialysis membrane, the mid cut-off (MCO) dialyzer, has been developed to improve the clearance of uremic toxins in hemodialysis (HD). The a tRial Evaluating Mid cut-Off Value membrane clearance of Albumin and Light chains in HemoDialysis patients (REMOVAL-HD) study aimed to determine if regular use of MCO dialyzer was safe and specifically did not result in a significant loss of albumin. Methods: This investigator initiated, crossover, longitudinal, device study was conducted across 9 centers in Australia and New Zealand (n = 89). Participants had a 4-week wash-in with high-flux HD, followed by 24-week intervention with MCO HD and a subsequent 4-week wash-out with high-flux HD. The primary outcome was change in serum albumin between weeks 4 and 28. Secondary outcomes included trends in serum albumin, changes in kappa- and lambda-free light chains (FLC), 6-min walk test (6MWT), malnutrition inflammation score (MIS), restless legs score and quality of life. Results: Participants had a mean age of 66 ± 14 years, 62% were men, 45% were anuric, and 51% had diabetes. There was no reduction in serum albumin following treatment with MCO HD (mean reduction –0.7 g/L, 95% CI –1.5 to 0.1). A sustained, unexplained reduction in serum albumin (>25%) was not observed in any participant. A reduction in FLC was observed 2 weeks into MCO HD (lambda-FLC: Δ –9.1 mg/L, 95% CI –14.4 to –3.7; kappa-FLC: Δ –5.7 mg/L, 95% CI –9.8 to –1.6) and was sustained for the rest of the study intervention. Both FLC increased after the cessation of MCO use. There was no improvement in restless legs symptoms, quality of life, 6MWT or MIS scores. Conclusions: Regular HD using the MCO dialyzer did not result in a significant fall in serum albumin. There were no effects on quality of life, functional status or nutrition. Trial Registration: Australian New Zealand Clinical Trials Registry Number (ANZCTRN) 12616000804482.read more
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Journal ArticleDOI
Classification of Uremic Toxins and Their Role in Kidney Failure.
Mitchell H. Rosner,Thiago Reis,Faeq Husain-Syed,Raymond Vanholder,Colin A. Hutchison,Colin A. Hutchison,Peter Stenvinkel,Peter J. Blankestijn,Mario Cozzolino,Laurent Juillard,Laurent Juillard,Kianoush Kashani,Manish Kaushik,Hideki Kawanishi,Ziad A. Massy,Tammy L. Sirich,Tammy L. Sirich,Li Zuo,Claudio Ronco +18 more
TL;DR: In this paper, a consensus conference was held to develop recommendations for an updated definition and classification scheme on the basis of a holistic approach that incorporates physicochemical characteristics and dialytic removal patterns of uremic retention solutes and their linkage to clinical symptoms and outcomes.
Journal ArticleDOI
Efficacy and Safety of Expanded Hemodialysis with the Theranova 400 Dialyzer: A Randomized Controlled Trial.
Daniel E. Weiner,Luke Falzon,Line Skoufos,Angelito A. Bernardo,Werner Beck,Mengqi Xiao,Ha Tran +6 more
TL;DR: Hemodialysis therapy with the Theranova 400 Dialyzer provides superior removal of larger middle molecules, as exemplified by free λ light chains, compared with a similar size high-flux dialyzer, while maintaining serum albumin levels after 24 weeks of treatment.
Journal ArticleDOI
Slipping Through the Pores: Hypoalbuminemia and Albumin Loss During Hemodialysis.
Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,Linda H. Ficociello,Jennifer Bazzanella,Claudy Mullon,Michael S. Anger +6 more
TL;DR: In this article, the impact of dialyzer selection on albumin losses during conventional hemodialysis, including the clinical relevance of such losses on serum albumin levels, is examined.
Journal ArticleDOI
High-volume online haemodiafiltration treatment and outcome of end-stage renal disease patients: more than one mode
TL;DR: Ongoing and future trials should provide definitive proof for the superiority of high-volume OL-HDF over conventional HD or HDx to give guidance for the most favourable mode of dialytic therapy for clinical use.
Journal ArticleDOI
Expanded Haemodialysis as a Current Strategy to Remove Uremic Toxins
Paola Ciceri,Mario Cozzolino +1 more
TL;DR: In this article, the authors proposed to target uremic toxins and/or their pathways, which may decrease the risk of cardiovascular disease in CKD patients and improve quality of life, morbidity and mortality.
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