Protein-bound Toxin Removal Between Limited Blood Flow Super High-flux Online HDF and High-Efficiency Online HDF
Protein-bound Toxin Removal Between Limited Blood Flow Super High-flux Online HDF and High-Efficiency Online HDF
High-efficiency post-dilution online hemodiafiltration (OL-HDF) using high-flux dialyzer and
 requiring high blood flow rate (BF ≥400 mL/min) has been reported to enhance protein-bound
 toxin and middle molecular toxin removal and improve patient survival. Unfortunately, the
 majority of patients could not reach that high BF because of vascular access issue. This
 randomized crossover study was conducted to compare these uremic toxin removals between the
 new modality (limited BF OL-HDF with super high-flux dialyzer) and the control
 (high-efficiency OL-HDF). The OL-HDF patients were randomized to undergo either new modality
 or control for 2 weeks before crossover to the other modality for another 2 weeks.
Elevated protein-bound toxins including p-cresol (pCS) and indoxyl sulfate (IDS) as well as
 middle-molecular toxins such as beta2-microglobulin (B2M) which could not be removed by
 hemodialysis (HD) are obviously correlated with high mortality. High-efficiency post-dilution
 online hemodiafiltration (OL-HDF) using high-flux dialyzer and requiring high blood flow rate
 (BF ≥400 mL/min) has been reported to enhance pCS, IDS, and B2M removal and improve patient
 survival. Unfortunately, the majority of patients could not reach that high BF because of
 vascular access issue. We innovated the OL-HDF modality for this limited BF situation by
 integrating the novel super high-flux membrane dialyzer (SHF; PES-17Dα, Nipro Corporation,
 Japan) into pre-dilution OL-HDF. This randomized crossover study was conducted to compare the
 uremic toxin removals between the new modality (limited BF OL-HDF with SHF) and the control
 (high-efficiency OL-HDF). The OL-HDF patients were randomized to undergo either new modality
 or control for 2 weeks before crossover to the other modality for another 2 weeks. Removals
 of pCS and IDS as well as small and middle molecule toxins were compared. The pCS and IDS
 were measured by high performance liquid chromatography. The dialysate albumin loss and
 patient safety were also monitored.
Inclusion Criteria:

 -  End-stage renal disease patients treated with thrice-a-week OL-HDF for at least 6
 months

 -  Residual urine < 100 mL/day

 Exclusion Criteria:

 -  Active cardiovascular disease

 -  Active malignancy

 -  Pregnancy

 -  Breast-feeding