Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study
Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study
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DOI：
10.1159/000508061
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发表时间：
2020-11-01
影响因子：
3
通讯作者：
Unsal, Abdulkadir
中科院分区：
文献类型：
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作者：
Sevinc, Mustafa;Hasbal, Nuri Baris;Unsal, Abdulkadir
简介：去除尿毒症毒素是血液透析的主要目标；然而，高通量和中截留 (MCO) 膜在去除中型和大型尿毒症毒素方面是否有所不同尚不清楚。目的：比较中截止和高通量透析器在透析内和透析间对中、大尿毒症毒素和血清白蛋白循环水平的影响。方法：52 名患者随机接受血液透析，使用 3 个月的高通量透析器，然后使用 3 个月的 MCO，反之亦然。在每个透析器的第一次和最后一次透析之前和之后采集血样，用于分析中大尿毒症毒素，包括炎症介质和血管内皮生长因子（VEGF）和血清白蛋白。结果：与高通量透析器相比，使用 MCO 透析器的第一次和最后一次疗程的减少率更高，且透析后 β-2 微球蛋白、游离 kappa 和 lambda 轻链以及肌球蛋白水平较低（全部 p < 0.05）。与高通量透析器相比，MCO 透析器中最后一次透析前的 β-2 微球蛋白、游离 kappa 轻链和游离 lambda 轻链的水平低于第一次透析前的水平（全部 p < 0.05）。最后一次透析中白细胞介素 6、白细胞介素 10、白细胞介素 17 和干扰素 γ 的水平在透析器之间没有差异（全部 p > 0.05）。与高通量组相比，MCO 组的 VEGF 水平较低 (p = 0.043)。使用 MCO 透析器的最后一次血清白蛋白水平低于使用高通量透析器的血清白蛋白水平（3.62 [3.45-3.88] 与 3.78 [3.58-4.02] g/L）（p = 0.04），并且比第一次使用 MCO 透析器时低 6.7% (p < 0.001)。结论：与高通量膜相比，血液透析后使用MCO膜使包括VEGF在内的几种中大型尿毒症毒素的循环水平下降更明显，但对炎症分子的影响相似。
Introduction: Removal of uremic toxins is a main objective of hemodialysis; however, whether high-flux and medium cut-off (MCO) membranes differ as regards removal of middle and large uremic toxins is not clear. Objective: To compare medium cut-off and high-flux dialyzers as regards their intra- and interdialysis effect on circulating levels of middle and large uremic toxins and serum albumin. Methods: Fifty-two patients were randomized to have hemodialysis with either 3 months of high-flux dialyzer followed by 3 months of MCO or vice versa. Blood samples were taken before and after dialysis at the first and last sessions of each dialyzer for analyses of middle and large uremic toxins including inflammatory mediators and vascular endothelial growth factor (VEGF), and serum albumin. Results: Reduction rates were higher, and postdialysis levels of beta-2 microglobulin, free kappa and lambda light chains, and myoglobulin were lower at the first and last sessions with MCO dialyzers compared to high-flux dialyzers (p < 0.05 for all). Last session predialysis levels of beta-2 microglobulin, free kappa light chain, and free lambda light chain were lower than first session predialysis levels in MCO dialyzers as compared to high-flux dialyzers (p < 0.05 for all). Last session levels of interleukin-6, interleukin-10, interleukin-17, and interferon-gamma did not differ between dialyzers (p > 0.05 for all). VEGF level was lower in the MCO group compared to the high-flux group (p = 0.043). Last session level of serum albumin with MCO dialyzers was lower than that with high-flux dialyzers (3.62 [3.45-3.88] vs. 3.78 [3.58-4.02] g/L) (p = 0.04) and 6.7% lower (p < 0.001) than at the first session of MCO dialyzers. Conclusion: The decline in circulating levels of several middle and large uremic toxins including VEGF following hemodialysis was more pronounced when using MCO membranes as compared to high-flux membranes while their effect on inflammatory molecules was similar.