Seminars in Dialysis最新文献

{"title":"Impact of Expanded Hemodialysis on Inflammation and Iron Metabolism in Chronic Hemodialysis Patients.","authors":"Berrak Itır Aylı, Gülay Ulusal Okyay, Mehmet Deniz Aylı","doi":"10.1111/sdi.70033","DOIUrl":"https://doi.org/10.1111/sdi.70033","url":null,"abstract":"<p><p>Microinflammation and functional iron deficiency are major contributors to anemia and treatment burden in maintenance hemodialysis (HD). Medium cutoff (MCO) membranes enhance the removal of middle- and large-sized solutes implicated in these pathways, yet real-world data using routinely measured inflammatory and iron-related markers are scarce. This study examined the effects of MCO-based expanded HD on inflammatory indices, iron metabolism, and anemia-related treatment requirements. In this single-center retrospective study, 22 maintenance HD patients (11 who continued on high-flux dialyzers and 11 who were switched to MCO dialyzers) were followed for 24 weeks. Baseline and 24-week assessments included C-reactive protein (CRP), the CRP/albumin ratio, neutrophil count, and composite inflammatory indices, as well as serum iron, transferrin saturation (TSAT), total iron-binding capacity (TIBC), and ferritin. Monthly intravenous iron supplementation and weekly erythropoiesis-stimulating agent (ESA) doses were also documented. Baseline characteristics were comparable between groups. Over the 24-week period, the MCO group showed a significant decline in neutrophil count (p = 0.042) and downward trends in CRP and the CRP/albumin ratio, while both markers increased significantly in patients maintained on high-flux dialyzers. Serum albumin remained stable in all participants. Parallel to the improvement in inflammation, the MCO group demonstrated significant enhancements in iron-handling parameters, with higher serum iron (p = 0.008) and TSAT (p = 0.005), and lower TIBC (p = 0.007), none of which were observed in the high-flux group. Between-group Δ-differences were significant for CRP (p = 0.010), CRP/albumin ratio (p = 0.013), serum iron (p = 0.040), TIBC (p = 0.005), and TSAT (p = 0.005). Hemoglobin levels remained stable in both groups, while intravenous iron and ESA requirements showed modest within-group reductions in the MCO cohort. In this exploratory retrospective analysis, MCO membrane use was associated with favorable trends in inflammatory markers and iron-handling parameters, alongside modest within-group reductions in intravenous iron and ESA requirements, without compromising serum albumin. These findings suggest that MCO therapy may help mitigate microinflammation and support more efficient anemia management in real-world HD practice.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phosphate Kinetic Modeling in Patients Treated With Hemodialysis or Hemodiafiltration: A Prospective, Multicenter, Cross-Sectional Study.","authors":"Hegbrant Jörgen, Bernat Amparo, Simorra Rita, Del Castillo Domingo, Pizarro Jose Luis, Jarava Carlos, Caparros Sonia, Strippoli Giovanni F M, Daugirdas John T","doi":"10.1111/sdi.70029","DOIUrl":"https://doi.org/10.1111/sdi.70029","url":null,"abstract":"<p><strong>Background: </strong>Studies suggest increased phosphate removal when using hemodiafiltration (HDF) compared with hemodialysis (HD), but a complete analytic comparison has not been reported.</p><p><strong>Methods: </strong>We analyzed data from a 6-month prospective, multicenter, cross-sectional study that enrolled patients treated with high-flux HD or HDF and in whom residual kidney phosphate clearances (KrPhos) were measured. Modeling data and dietary survey data were available from 115 patients (59 treated with HD and 56 treated with HDF).</p><p><strong>Results: </strong>Predialysis (midweek) serum phosphate values averaged 4.37 ± 1.00 and 4.60 ± 1.18 mg/dL in the HD and HDF groups (p = NS). Mean prescribed phosphate binder equivalent dose (PBED) (including zero values) was 3.33 ± 2.94 g/day in HD and 2.64 ± 2.68 g/day in HDF (p = 0.19). Mean modeled phosphate ingestion was similar in HD and HDF (911 ± 231 vs. 911 ± 300 mg/day, p = NS), but phosphate ingestion by dietary survey was higher in HDF vs. HD (1119 ± 520 vs. 801 ± 420 mg/day, p < 0.001). Mean predialysis serum phosphate values in patients with residual kidney function (defined as KrPhosWater > 1.0 mL/min) and anuric patients were similar (4.43 ± 0.73 vs. 4.50 ± 1.20 mg/dL, respectively), whereas mean prescribed PBED was lower in patients with KrPhosWater > 1.0 mL/min (1.83 ± 2.02 vs. 3.40 ± 2.96 g/day, p < 0.01).</p><p><strong>Conclusions: </strong>Predialysis serum phosphate is not always lower in patients treated with HDF compared with HD, and this can possibly be explained by a trend to a lower prescribed PBED and/or by a higher dietary phosphate intake.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Hematoma Following Initial Arteriovenous Fistula Puncture in a Hemodialysis Patient, Emphasizing Thoracic Outlet Syndrome: A Case Report.","authors":"Yan Zhang, Lin Chen, Xianglei Kong, Sha Sha, Jimei Liu, Lili Wang, Hong Ji","doi":"10.1111/sdi.70023","DOIUrl":"https://doi.org/10.1111/sdi.70023","url":null,"abstract":"<p><strong>Background: </strong>Hematoma is a common complication following arteriovenous fistula (AVF) cannulation in hemodialysis patients; however, rapid progression to tension blister formation is rare.</p><p><strong>Case report: </strong>We describe a case involving a 62-year-old male on maintenance hemodialysis, who initially received treatment via a tunneled right internal jugular catheter with a polyester cuff. Approximately 10 weeks after the creation of a right forearm AVF, the patient underwent first-time AVF cannulation. After 2 h, he developed a hematoma at the puncture site, followed by extensive tension blisters the next day. Computed tomography angiography (CTA) revealed significant stenosis of the right subclavian vein. Conservative treatment, including antibiotics, microcirculation enhancement, and wound care, led to recovery. Based on this case, we revised our center's protocol for AVF assessment and early use during the first 3 months post-creation.</p><p><strong>Conclusions: </strong>In patients with newly matured AVFs-particularly those with a history of ipsilateral central venous catheterization-screening for thoracic outlet syndrome should be integrated into pre-cannulation assessments (e.g., AVF blood flow is dynamically evaluated with the arm in multiple positions). Standardizing AVF use during the activation period may reduce complications and help prolong fistula patency.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Nomogram to Predict the Difficult Transradial Approach for Percutaneous Transluminal Angioplasty in Radiocephalic Arteriovenous Fistulas.","authors":"Jiali Liu, Kun Zhang, Zhiqiang Duan, Fei Yin, Heping Zhang","doi":"10.1111/sdi.70027","DOIUrl":"https://doi.org/10.1111/sdi.70027","url":null,"abstract":"<p><strong>Background: </strong>The transradial approach (TRA) is a critical access method for percutaneous transluminal angioplasty (PTA) in hemodialysis (HD) patients with arteriovenous fistula (AVF) dysfunction, yet its technical challenges remain unaddressed. Currently, no predictive tools exist to assess TRA feasibility. This study aimed to identify risk factors for difficult TRA and develop a predictive nomogram.</p><p><strong>Methods: </strong>We retrospectively analyzed 160 HD patients undergoing ultrasound-guided TRA-PTA across three Chinese hospitals (May 2022-May 2024). A training cohort (n = 110) and validation cohort (n = 50) were established. Independent risk factors were identified via univariate and multivariate logistic regression. A nomogram was constructed and validated using ROC curves, calibration plots, and decision curve analysis (DCA).</p><p><strong>Results: </strong>The cohort had a mean age of 59.7 ± 12.9 years, with 36.9% (59/160) experiencing difficult TRA. Radial artery diameter (OR = 2.1, p = 0.003), calcification (OR = 3.4, p < 0.001), and tortuosity (OR = 2.8, p = 0.002) were independent predictors. The nomogram demonstrated strong discrimination (AUC: 0.902), with sensitivity = 0.907 and specificity = 0.806 at a cutoff of 0.416. Calibration showed excellent agreement (mean absolute error = 0.022), and DCA confirmed clinical utility across threshold probabilities of 0.2-0.8.</p><p><strong>Conclusion: </strong>This nomogram demonstrates that for optimal puncture feasibility, the radial artery diameter should be ≥ 3 mm when both calcification and tortuosity are present, > 2.2 mm if either condition is present, and > 1.5 mm if neither is present. The nomogram effectively predicts difficult TRA during AVF-PTA in HD patients, offering clinicians a practical tool to preoperatively assess procedural feasibility and optimize vascular access planning.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Predictors of Tunneled Central Venous Catheter Dysfunction in Hemodialysis: A Multicenter Retrospective Cohort With Repeated-Measure Sessions.","authors":"Verónica Gimeno-Hernán, Ana Belén Rivas-Paterna, Carla Pérez-Ingidua, Ana Ascaso-Del-Río, Marina Gómez-Esteban, Ismael Ortuño-Soriano","doi":"10.1111/sdi.70034","DOIUrl":"https://doi.org/10.1111/sdi.70034","url":null,"abstract":"<p><strong>Background: </strong>Tunneled central venous catheter dysfunction is a frequent and clinically relevant complication in hemodialysis, with a direct impact on treatment efficacy and vascular access survival. Identifying modifiable risk factors is essential for optimizing prevention strategies and guide clinical decision-making. This study aimed to identify predictors of tunneled central venous catheter dysfunction through a retrospective multicenter cohort of hemodialysis sessions with repeated measures cross-sectional, while other cross-sectional approaches-such as the one presented here-focus on data collected during each HD session to detect early warning signs of dysfunction, following KDOQI 2019 guidelines for vascular access dysfunction definition. The secondary objective was to explore associations.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study with repeated measures was conducted using all hemodialysis sessions performed in 2021 in 18 public hospitals. The unit of analysis was the index session, and the primary outcome was catheter dysfunction in the subsequent session, defined as blood flow < 300 mL/min with associated arterial or venous pressure changes. A mixed-effects logistic regression with a random intercept for each patient was fitted to account for the repeated hemodialysis sessions.</p><p><strong>Results: </strong>Significant associations were found between catheter dysfunction and lower blood flow rates, elevated venous pressures, line inversion, and catheter placement in the left internal jugular vein. Protective factors included urokinase locking and post-dilution hemodiafiltration. Higher risk was also linked to interstitial nephropathies and unknown etiologies, whereas prior vascular access reduced the risk of dysfunction.</p><p><strong>Conclusion: </strong>Tunneled central venous catheter dysfunction is a preventable complication when clinical, technical, and hemodynamic parameters are systematically monitored to identify risk factors and guide catheter management. Continuous session-based monitoring enables early detection and timely intervention. This comprehensive strategy, when combined with pharmacologic management, helps preserve vascular access and enhances treatment outcomes in hemodialysis patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Prediction Models for Frailty in Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis.","authors":"Fan Yang, Hua Kang, Shuyao Wang, Yiting Wang, Huiyu Hu","doi":"10.1111/sdi.70025","DOIUrl":"https://doi.org/10.1111/sdi.70025","url":null,"abstract":"<p><strong>Objective: </strong>The aim is to systematically evaluate the frailty risk prediction models for Chinese maintenance hemodialysis patients and to provide a reference for the construction and optimization of such models.</p><p><strong>Methods: </strong>Relevant studies on prediction models for frailty in Chinese maintenance hemodialysis patients were retrieved from PubMed, Embase, Web of Science, Cochrane Library, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and VIP Database. The search period was from the inception of each database to October 23, 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of the included models using the Prediction model Risk of Bias Assessment Tool (PROBAST). A meta-analysis of predictors was performed using Stata 18.0 software.</p><p><strong>Results: </strong>A total of 13 studies from China were included, which developed 15 distinct prediction models. These models involved 4341 patients. The area under the receiver operating characteristic curve (AUC) for these models ranged from 0.722 to 0.998, indicating good predictive performance (AUC > 0.7). However, the overall risk of bias was high, primarily in the domain of data analysis. The meta-analysis identified the following significant predictors of frailty (p < 0.05): age (OR = 1.14, 95% CI 1.05-1.23), serum albumin (OR = 0.66, 95% CI 0.52-0.83), exercise (OR = 0.50, 95% CI 0.49-0.63), comorbidity (OR = 1.70, 95% CI 1.47-1.97), nutritional score (OR = 3.64, 95% CI 1.53-8.67), ADL score (OR = 0.77, 95% CI 0.68-0.88), female sex (OR = 6.24, 95% CI 1.97-19.80), and depression (OR = 1.26, 95% CI 1.04-1.53).</p><p><strong>Conclusion: </strong>Our results indicate the incidence of frailty among maintenance hemodialysis patients in China is as high as 39%. The identified predictors-advanced age, hypoalbuminemia, physical inactivity, comorbidities, poor nutritional status, impaired activities of daily living, female sex, and depression-form the basis for developing targeted preventive measures for frail patients on maintenance hemodialysis. The prediction model of frailty risk in maintenance hemodialysis patients in China is still in its infancy. Future research can refer to the model construction method of this study and the common predictors integrated by meta-analysis and select appropriate methods to develop and verify the frailty prediction model in combination with clinical practice. Targeted preventive measures should be given to maintenance hemodialysis patients with high risk in the early stage.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Green Dialysis: A Framework for Environmentally Sustainable Renal Replacement Therapy.","authors":"Pranav Sivaram, Toby Johnson, Mojgan Mortazavi, Urmila Anandh, Jing Chen, Fernanda Oliveira Coelho, Simon Davies, Rasha Darwish, Faiçal Jarraya, Zehra Aydin, K S Nayak, Talerngsak Kanjanabuch, Sourabh Sharma, Rupesh Raina","doi":"10.1111/sdi.70028","DOIUrl":"https://doi.org/10.1111/sdi.70028","url":null,"abstract":"<p><strong>Background: </strong>Dialysis is a life-sustaining therapy for patients with end-stage renal disease, yet it is among the most resource-intensive treatments in modern healthcare. Hemodialysis requires large volumes of treated water, substantial energy input, and extensive single-use consumables, resulting in significant greenhouse gas emissions and clinical waste when scaled to millions of treatments performed annually. Climate change further threatens kidney health through heat stress, dehydration, and climate-related disruptions, creating a bidirectional relationship in which kidney care both contributes to and is adversely affected by environmental degradation.</p><p><strong>Methods: </strong>This white paper synthesizes current evidence surrounding environmentally sustainable dialysis practices, collectively termed \"green dialysis,\" reviewing technical and system-level interventions across water stewardship, energy management, waste reduction, and clinical practice innovation.</p><p><strong>Results: </strong>Green dialysis strategies, including dialysate flow optimization, improved reverse-osmosis efficiency and water reuse, energy-efficient infrastructure, renewable energy integration, waste segregation, central concentrate delivery systems, and incremental dialysis, have been shown to reduce water consumption, energy use, waste generation, and operational costs while maintaining dialysis adequacy and clinical outcomes. Adoption remains uneven due to operational complexity, regulatory gaps, and financial constraints, particularly in low- and middle-income countries.</p><p><strong>Conclusions: </strong>Context-sensitive implementation, staff education, standardized monitoring, and transparent reporting are essential for overcoming these barriers. Broader integration of sustainability into routine dialysis care represents a critical opportunity to reduce the environmental footprint of kidney replacement therapy without compromising patient safety or treatment efficacy.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Bioremediation: A Rare Case of Comamonas testosteroni Bloodstream Infection in a Patient With Stage 5 Chronic Kidney Disease on Maintenance Hemodialysis.","authors":"Syeda Bushra Fatima, Moiz Ahmed Khan, Summaya Zafar","doi":"10.1111/sdi.70026","DOIUrl":"https://doi.org/10.1111/sdi.70026","url":null,"abstract":"<p><p>Comamonas testosteroni is a gram-negative aerobic bacillus commonly found in environmental sources and known for its bioremediation potential. Although it is widely distributed in nature, human infection is rare, but it is increasingly being recognized as a nosocomial pathogen. A 68-year-old female with stage 5 chronic kidney disease (CKD V) on maintenance hemodialysis since 2017 presented with fever and decreased consciousness. On examination, a tunneled cuffed catheter (TCC) was noted in the right internal jugular vein. Two sets of blood cultures, one drawn from the TCC and the other from a peripheral vein, grew C. testosteroni after 48 h. The organism was identified using API ID strips and was sensitive to amikacin, gentamicin, ceftazidime, imipenem, and meropenem but resistant to ciprofloxacin. She was treated with catheter removal and intravenous ceftazidime. The patient recovered completely after 5 days of hospitalization, with resolution of fever and improved consciousness. This case highlights C. testosteroni as an emerging nosocomial pathogen in immunocompromised patients undergoing invasive procedures. It underscores the importance of vigilant surveillance and strict catheter management protocols.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Correlates of Physical Activity Among Hemodialysis Patients: A Systematic Review and Meta-Analysis.","authors":"Lin-Fan, Hong-Li Li, Jing-Tong Luo, Tian-Ming Song","doi":"10.1111/sdi.70019","DOIUrl":"10.1111/sdi.70019","url":null,"abstract":"<p><p>Physical activity has been recommended as an effective strategy to prevent complications in patients receiving hemodialysis. Multiple guidelines for chronic kidney disease recommend at least 150 min per week of moderate-intensity physical activity. However, the prevalence of meeting recommended physical activity levels among hemodialysis patients remains unclear, and the factors influencing physical activity participation require further investigation. We systematically searched PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, PsycINFO, China National Knowledge Infrastructure, WanFang, Chinese Biomedical Literature Service System, and SPORTDiscus from inception to March 5, 2025. The Agency for Healthcare Research and Quality was used to evaluate the methodological quality of included studies. The pooled prevalence was calculated using a random-effects model. Subgroup analysis was conducted to explore sources of heterogeneity. We screened 24,566 records, reviewed 252 full texts, and included 12 studies (N = 8938). The pooled prevalence of meeting recommended physical activity was 32% (95% CI, 20%-46%). Higher prevalence was observed in studies with shorter dialysis vintage, self-administered PA instruments, smaller sample sizes, and those published before 2020. Factors underlying inactivity were multifactorial, spanning pathophysiological, psychological, and treatment-related domains. This review indicates a low prevalence of meeting recommended physical activity levels among hemodialysis patients, which is influenced by multiple factors. It is recommended that future studies further explore intervention strategies targeting physical activity on dialysis and non-dialysis days, based on factors that influence physical activity, to improve adherence.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"3-14"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency and Safety of Different Medium Cut-Off Membranes in Maintenance Hemodialysis Patients.","authors":"Gurkan Yurteri, Ahmet Murt","doi":"10.1111/sdi.70017","DOIUrl":"10.1111/sdi.70017","url":null,"abstract":"<p><strong>Background: </strong>Due to the accumulation of uremic toxins, hemodialysis patients exhibit a variety of symptoms and increased mortality. With their unique pore size and distribution, medium cut-off (MCO) membranes can provide clearance of middle-sized uremic toxins without causing albumin loss. Such a property may decrease overall mortality in hemodialysis patients. This study aims to analyze the effects of MCO membranes on the clearance of β₂-microglobulin, tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) to assess the safety of using these membranes and to compare two different MCO membranes.</p><p><strong>Methods: </strong>This was a prospective observational study. Sixty hemodialysis patients who had been dialyzed thrice weekly via high flux dialyzers were switched to one of two MCO dialyzers (Elisio Hx or Theranova) for 1 month. The mean age was 58.7 ± 13.4 years, and the mean dialysis vintage was 65.8 ± 58.6 months. Serum levels of β₂-microglobulin, TNF-α, and IL-6 were compared by paired-samples t test between the end and the beginning of the study period. Dialysis adequacy, electrolytes, heparin doses, low-density lipoprotein (LDL), hemoglobin, and albumin levels were also compared. In addition, the performance of the two MCO dialyzers was compared using an independent-samples t test.</p><p><strong>Results: </strong>There was a significant decrease in β₂-microglobulin (p = 0.02), LDL (p < 0.01), and albumin levels (p < 0.001) at the end of the study. Dialysis adequacy, hemoglobin, phosphorus, C-reactive protein, IL-6, and TNF-α levels did not change significantly. Among patients receiving standard heparin for anticoagulation, heparin doses had to be increased during MCO membrane use. The performance of the two different dialyzers was not statistically different.</p><p><strong>Conclusions: </strong>MCO membranes provide clearance of middle-sized uremic toxins. This effect is most prominent for β₂-microglobulin and does not differ between the two MCO dialyzers studied. MCO membranes may cause some albumin loss, and heparin requirements may increase during their use.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"26-32"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}