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Maduell F, Broseta JJ, Rodríguez-Espinosa D, Rodas LM, Gómez M, Arias-Guillén M, Fontseré N, Vera M, Salgado MDC, Rico N, Ramos R. Comparison of efficacy and safety of the new generation helixone dialyzers. Nefrologia 2024; 44:354-361. [PMID: 38679516 DOI: 10.1016/j.nefroe.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION New generation helixone dialyzers has recently been developed as part of the ongoing effort to improve dialyzer hemocompatibility and avoid adverse reactions to synthetic dialyzers. This study aimed to assess the performance and albumin loss of this new dialyzer series in hemodiafiltration and compare it with the previous generation helixone series. MATERIAL AND METHODS A prospective study was conducted in 19 patients. Each patient underwent eight dialysis sessions with the same routine dialysis parameters; only the dialyzer varied: FX60 CorDiax, FX CorAL 60, FX600 CorDiax, FX CorAL 600, FX80 CorDiax, FX CorAL 80, FX800 CorDiax, and FX CorAL 800. The reduction ratios (RR) of urea, creatinine, ß2-microglobulin, myoglobin, kappa-free immunoglobulin light chains (κFLC), prolactin, α1-microglobulin, α1-acid glycoprotein, lambda immunoglobulin light chains (λFLC), and albumin were compared intra-individually. Dialysate albumin loss was also measured. RESULTS All treatments were well tolerated. The mean amount of replacement fluid ranged from 31 to 34 L. Comparison of dialysis treatments showed no differences between small molecules and even up to those the size of β2-microglobulins. Little differences were found between myoglobin, κFLC, prolactin, α1-microglobulin, and λFLC RRs, and only FX80 CorDiax was slightly superior to the others. Mean dialysate albumin losses were similar, with less than 2.5 g lost in each dialyzer. The FX80 CorDiax showed slightly higher global removal scores than the other dialyzers evaluated, except for FX CorAL 800. CONCLUSION The new generation helixone dialyzers series has been updated to minimise the risk of adverse reactions, while maintaining the effectiveness and albumin loss achieved by the previous most advanced helixone generation.
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Affiliation(s)
- Francisco Maduell
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain.
| | - José Jesús Broseta
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain
| | | | - Lida María Rodas
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain
| | - Miquel Gómez
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain
| | - Marta Arias-Guillén
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain
| | - Néstor Fontseré
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain
| | - Manel Vera
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain
| | | | - Nayra Rico
- Servicio de Bioquímica, Hospital Clínic, Barcelona, Spain
| | - Rosa Ramos
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, Spain
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Maduell F, Rodríguez-Espinosa D, Broseta JJ. Latest Trends in Hemodiafiltration. J Clin Med 2024; 13:1110. [PMID: 38398423 PMCID: PMC10888566 DOI: 10.3390/jcm13041110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
This review provides a detailed analysis of hemodiafiltration (HDF), its progress from an emerging technique to a potential conventional treatment for chronic hemodialysis patients, and its current status. The article covers the advances, methods, and clinical benefits of HDF, specifically focusing on its impact on cardiovascular health, survival rates, and overall well-being. The review also addresses questions about the safety of HDF and provides evidence to dispel concerns related to the elimination of beneficial substances and infection risks. Additionally, the article explores the potential implications of expanded hemodialysis (HDx) as an alternative to HDF, its classification, safety profile, and an ongoing trial assessing its non-inferiority to HDF. Supported by evidence from randomized controlled trials and observational studies, the review emphasizes the superiority of HDF as a hemodialysis modality and advocates for its positioning as the gold standard in treatment. However, it acknowledges the need for extensive research to define the role of HDx in comprehensive treatment approaches in individuals undergoing dialysis. The synthesis of current knowledge underscores the importance of ongoing exploration and research to refine hemodialysis practices for optimal patient outcomes.
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Affiliation(s)
- Francisco Maduell
- Department of Nephrology, Hospital Clínic, 08036 Barcelona, Spain; (D.R.-E.); (J.J.B.)
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Ehlerding G, Ries W, Kempkes-Koch M, Ziegler E, Erlenkötter A, Zawada AM, Kennedy JP, Ottillinger B, Stauss-Grabo M, Lang T. Randomized comparison of three high-flux dialyzers during high-volume online hemodiafiltration—the comPERFORM study. Clin Kidney J 2021; 15:672-680. [PMID: 35464193 PMCID: PMC9022458 DOI: 10.1093/ckj/sfab196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Dialyzers should be designed to efficiently eliminate uraemic toxins during dialysis treatment, given that the accumulation of small and middle molecular weight uraemic solutes is associated with increased mortality risk of patients with end-stage renal disease. In the present study we investigated the novel FX CorAL dialyzer with a modified membrane surface for performance during online hemodiafiltration (HDF) in a clinical setting. Methods comPERFORM was a prospective, open, controlled, multicentric, interventional, crossover study with randomized treatment sequences. It randomized stable patients receiving regular post-dilution online HDF to FX CorAL 600 (Fresenius Medical Care Deutschland), xevonta Hi 15 (B. Braun) and ELISIO 150H (Nipro) each for 1 week. The primary outcome was β2-m removal rate (β2-m RR) during online HDF. Secondary endpoints were RR and/or clearance of β2-m and other molecules. Albumin removal over time was an exploratory endpoint. Non-inferiority and superiority of FX CorAL 600 versus comparators were tested. Results Fifty-two patients were included and analysed. FX CorAL 600 showed the highest β2-m RR (75.47%), followed by xevonta Hi 15 (74.01%) and ELISIO 150H (72.70%). Superiority to its comparators was statistically significant (P = 0.0216 and P < 0.0001, respectively). Secondary endpoints related to middle molecules affirmed these results. FX CorAL 600 demonstrated the lowest albumin removal up to 60 minutes and its sieving properties changed less over time than with comparators. Conclusions FX CorAL 600 efficiently removed middle and small molecules and was superior to the two comparators in β2-m RR. Albumin sieving kinetics point to reduced formation of a secondary membrane.
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Affiliation(s)
- Götz Ehlerding
- Zentrum für Nieren-, Hochdruck- und Stoffwechselerkrankungen, Hannover, Germany
| | - Wolfgang Ries
- Diakonissenkrankenhaus, Innere Medizin, Abtlg. Nephrologie, Flensburg, Germany
| | | | | | - Ansgar Erlenkötter
- Fresenius Medical Care Deutschland, Global Research and Development, Biotechnology (WND), St. Wendel, Germany
| | - Adam M Zawada
- Fresenius Medical Care Deutschland, Global Research and Development, Product Engineering Center Dialyzers and Membranes, St. Wendel, Germany
| | - James P Kennedy
- Fresenius Medical Care Deutschland, Global Research and Development, Product Engineering Center Dialyzers and Membranes, St. Wendel, Germany
| | - Bertram Ottillinger
- Institut Dr Schauerte GbR (IDS), München, Germany
- Ottillinger Life Sciences, Brunnthal, Germany
| | - Manuela Stauss-Grabo
- Fresenius Medical Care Deutschland, Clinical Research, EMEA, AP & LA, Global Medical Office, Bad Homburg, Germany
| | - Thomas Lang
- Fresenius Medical Care Deutschland, Clinical Research, EMEA, AP & LA, Global Medical Office, Bad Homburg, Germany
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Ehlerding G, Erlenkötter A, Gauly A, Griesshaber B, Kennedy J, Rauber L, Ries W, Schmidt-Gürtler H, Stauss-Grabo M, Wagner S, Zawada AM, Zschätzsch S, Kempkes-Koch M. Performance and Hemocompatibility of a Novel Polysulfone Dialyzer: A Randomized Controlled Trial. ACTA ACUST UNITED AC 2021; 2:937-947. [PMID: 35373083 PMCID: PMC8791382 DOI: 10.34067/kid.0000302021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
Abstract
AbstractBackgroundHigh-flux dialyzers effectively remove uremic toxins, are hemocompatible to minimize intradialytic humoral and cellular stimulation, and have long-term effects on patient outcomes. A new dialyzer with a modified membrane surface has been tested for performance and hemocompatibility.MethodsThis multicenter, prospective, randomized, crossover study involved the application of the new polysulfone-based FX CorAL 600 (Fresenius Medical Care, Bad Homburg, Germany), the polyarylethersulfone-based Polyflux 170H (Baxter Healthcare Corporation, Deerfield, IL), and the cellulose triacetate–based SureFlux 17UX (Nipro Medical Europe, Mechelen, Belgium), for 1 week each, to assess the noninferiority of the FX CorAL 600’s removal rate of β2-microglobulin. Performance was assessed by removal rate and clearance of small- and medium-sized molecules. Hemocompatibility was assessed through markers of complement, cell activation, contact activation, and coagulation.ResultsOf 70 patients, 58 composed the intention-to-treat population. The FX CorAL 600’s removal rate of β2-microglobulin was noninferior to both comparators (P<0.001 versus SureFlux 17UX; P=0.0006 versus Polyflux 170H), and superior to the SureFlux 17UX. The activation of C3a and C5a with FX CorAL 600 was significantly lower 15 minutes after treatment start than with SureFlux 17UX. The activation of sC5b-9 with FX CorAL 600 was significantly lower over the whole treatment than with SureFlux 17UX, and lower after 60 minutes than with the Polyflux 170H. The treatments with FX CorAL 600 were well tolerated.ConclusionsFX CorAL 600 efficiently removed small- and medium-sized molecules, showed a favorable hemocompatibility profile, and was associated with a low frequency of adverse events in this study, with a limited patient number and follow-up time. Further studies, with longer observation times, are warranted to provide further evidence supporting the use of the new dialyzer in a wide range of therapeutic options, and for long-term treatment of patients on hemodialysis, to minimize the potential effects on inflammatory processes.
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Santos García A, Macías Carmona N, Vega Martínez A, Abad Estébanez S, Linares Grávalos T, Aragoncillo Sauco I, Verdalles Guzmán U, Panizo González N, Cruzado Vega L, López Gómez JM. Removal capacity of different high-flux dialyzers during postdilution online hemodiafiltration. Hemodial Int 2018; 23:50-57. [PMID: 30367698 DOI: 10.1111/hdi.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/02/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The aim of this study is to compare molecule removal and albumin leakage in postdilution online hemodiafiltration with different high-flux dialyzers. METHODS We studied seven high-flux dialyzers (Polyflux 210H®, Evodial 2.2®, FxCordiax1000®, Elisio21H®, TS-2.1SL®, XevontaHi20®, VitaPES 210-HF®) in 6 patients. The reduction ratio (RR) of small- and middle-sized molecules was calculated. Dialysate samples were collected to estimate the albumin leakage. FINDINGS Global differences between dialyzers were observed in the RR of ß2 microglobulin (P =0.003) and prolactin (P =0.013). The mean loss of albumin in the dialysate per session varied between 114 ± 67 mg (with Evodial 2.2) and 2621 ± 1363 mg per session (with XevontaHi20). We found global differences between dialyzers in total albumin loss (P = 0.05). DISCUSSION We demonstrated that the performance of high-flux dialyzers was different among the types and that not all high-flux dialyzers should be considered equal.
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