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Systematic Comparison of Uremic Toxin Removal Using Different Hemodialysis Modes: A Single-Center Crossover Prospective Observational Study

Authors :
Ariane Duval-Sabatier
Stephane Burtey
Marion Pelletier
Manon Laforet
Laetitia Dou
Marion Sallee
Anne-Marie Lorec
Hafssa Knidiri
Floriane Darbon
Yvon Berland
Philippe Brunet
Source :
Biomedicines. 11:373
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Many hypotheses could explain the mortality decrease observed using hemodiafiltration, such as reduction of intradialytic hypotension and more efficient toxin removal. We led a systematic analysis of representative uremic toxin removal with hemodialysis (HD), online postdilution hemodiafiltration (postHDF) and online predilution hemodiafiltration (preHDF), in a single-center crossover and prospective observational study. The primary outcome was the reduction ratio of uremic toxins of the three categories defined by the Eutox group. Twenty-six patients were treated by those three techniques of extra renal epuration. Mean Kt/Vurea was not different between the treatment methods. Mean reduction ratio of beta2microglobulin was significantly higher for both HDF treatments than for HD (p < 0.001). Myoglobin, kappa, and lambda free light chain reduction ratio was significantly different between the modes: 37.75 ± 11.95%, 45.31 ± 11% and 61.22 ± 10.56%/57.21 ± 12.5%, 63.53 ± 7.93%, and 68.40 ± 11.79%/29.12 ± 8.44%, 34.73 ± 9.01%, and 45.55 ± 12.31% HD, preHDF, and postHDF, respectively (p < 0.001). Mean protein-bound solutes reduction ratio was not different between the different treatments except for PCS with a higher reduction ratio during HDF treatments. Mean albumin loss was always less than 2 g. HDF improved removal of middle molecules but had no effect on indoles concentration without any difference between synthetic dialysis membranes.

Details

ISSN :
22279059
Volume :
11
Database :
OpenAIRE
Journal :
Biomedicines
Accession number :
edsair.doi...........de9f5d0b1099619f4fef722cd9a445c4
Full Text :
https://doi.org/10.3390/biomedicines11020373