{"title":"Impact of No Anticoagulation, Citrate Anticoagulation, and Heparin Anticoagulation on CRRT Outcomes in Patients with Hyperlactatemia: A Retrospective Cohort Study.","authors":"Yaxin Xiong, Xiqing Luo, Jianpeng Wang, Quankuan Gu, Jiuyue Sun, Ze Meng, Shuang Tang, Jun Lyu, Mingyan Zhao, Xianglin Meng, Xianglin Meng","doi":"10.1159/000546195","DOIUrl":"10.1159/000546195","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous renal replacement therapy (CRRT) is one of the most critical interventions in the intensive care unit, and anticoagulation is essential to ensure its efficacy. Regional citrate anticoagulation (RCA) has been widely adopted in clinical practice due to its reduced risk of bleeding complications. However, the suitability of RCA for CRRT in patients with hyperlactatemia remains controversial.</p><p><strong>Methods: </strong>This study aimed to evaluate the efficacy and safety of different anticoagulation strategies (heparin systemic anticoagulation, RCA, and no anticoagulation) during CRRT in critically ill patients with hyperlactatemia. Using a retrospective cohort design, we analyzed clinical data from the MIMIC-IV v3.0 database, employing propensity score matching and multivariable Cox regression models to adjust for confounding factors.</p><p><strong>Results: </strong>Our findings demonstrated that compared to the no-anticoagulation group, the citrate group exhibited significantly lower 28-day, 60-day, and 90-day mortality risks, with hazard ratios (HRs) of 0.623, 0.650, and 0.657, respectively. In contrast, the heparin group showed a significant reduction only in 28-day mortality risk (HR = 0.625). These results were further validated in the matched cohort, indicating that RCA significantly improves clinical outcomes and reduces mortality in hyperlactatemia patients requiring CRRT.</p><p><strong>Conclusion: </strong>In summary, our study indicates that citrate anticoagulation significantly improves the prognosis of CRRT in patients with hyperlactatemia, suggesting its potential as a preferred anticoagulation strategy in this clinical setting.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"424-436"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2025-06-18DOI: 10.1159/000546598
Isabel Cristina Saravia Bermeo, Gonzalo Ramírez-Guerrero, Milene Angulo Juliao, Daniel Molina Comboni, Cristhian Bueno Lara, Maria Adelaida Zapata Zapata
{"title":"Evaluation of a Training Program in Peritoneal Dialysis Catheter Insertion for Nephrologists in South America.","authors":"Isabel Cristina Saravia Bermeo, Gonzalo Ramírez-Guerrero, Milene Angulo Juliao, Daniel Molina Comboni, Cristhian Bueno Lara, Maria Adelaida Zapata Zapata","doi":"10.1159/000546598","DOIUrl":"10.1159/000546598","url":null,"abstract":"<p><p><p>Introduction: For patients requiring renal replacement therapy, peritoneal dialysis (PD) offers an alternative to maintain quality of life. The long-term success of PD depends on using a safe, functional, and durable peritoneal catheter (PC). This study aimed to assess the outcomes of a training program for nephrologists on PD catheter insertion in South American dialysis centers.</p><p><strong>Methods: </strong>This longitudinal, retrospective, multicenter study was conducted in Colombia, Chile, Ecuador, and Bolivia. Patients who underwent PC insertion between January 2022 and May 2023 were included, with procedures performed by nephrologists trained in a specialized program. Data on population characteristics, procedural details, and catheter function at the first, third, and sixth months were collected.</p><p><strong>Results: </strong>A total of 117 subjects were included (median age 59 years, 50.4% men). Hypertension and diabetes were the primary causes of kidney disease (34.19% and 49.57%, respectively). Bladder emptying and prophylactic antibiotics were administered before the procedure. Most PC insertions (86.32%) were performed under local anesthesia, with the modified Seldinger technique. Catheter implantation was successful in 96.58% of cases. Elective PD was performed in 69.91% of patients, while 30.01% required urgent PD. Within the first 2 weeks, complications occurred in 7.08% of patients, including catheter tip migration and flow failure. At one, three, and 6 months of follow-up, complications were observed in 1.79%, 3.77%, and 11.00% of patients, respectively. Catheter patency was maintained in 99.10%, 96.22%, and 96.00% of patients at 1, 3, and 6 months, respectively.</p><p><strong>Conclusions: </strong>Optimal peritoneal access can be achieved through educational programs for nephrologists on catheter insertion, ensuring proper placement and maintenance, and resulting in low complication rates in PD patients. </p>.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"474-482"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2024-09-05DOI: 10.1159/000541239
Byeongo Choi, Chang Min Heo, Jiyae Yi, Dong Ah Lee, Yoo Jin Lee, Sihyung Park, Yang Wook Kim, Junghae Ko, Bong Soo Park, Kang Min Park
{"title":"Effect of Dialysis on Structural Brain Connectivity in Patients with End-Stage Renal Disease.","authors":"Byeongo Choi, Chang Min Heo, Jiyae Yi, Dong Ah Lee, Yoo Jin Lee, Sihyung Park, Yang Wook Kim, Junghae Ko, Bong Soo Park, Kang Min Park","doi":"10.1159/000541239","DOIUrl":"10.1159/000541239","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with end-stage renal disease (ESRD) are known to have reduced structural and functional brain connectivity in the brain regions associated with cognitive function. However, the effect of dialysis on brain connectivity remains unclear. This study aimed to evaluate the effects of dialysis on structural brain connectivity in patients with ESRD.</p><p><strong>Methods: </strong>This prospective study included 20 patients with ESRD in the pre-dialysis stage and 35 healthy controls. The patients underwent T2-weighted and three-dimensional T1-weighted magnetic resonance imaging before and 3 months after dialysis initiation. Moreover, the cortical thickness was calculated. We applied graph theoretical analysis to calculate the structural covariance network based on cortical thickness. We compared the cortical thickness and structural covariance network of patients with ESRD in the pre-dialysis stage with those of healthy controls and with those of patients with ESRD in the post-dialysis stage.</p><p><strong>Results: </strong>The mean cortical thickness in both hemispheres was lower in patients with ESRD in the pre-dialysis stage than in healthy controls (2.296 vs. 2.354, p = 0.030; 2.282 vs. 2.362, p = 0.004, respectively) and was higher in patients with ESRD in the post-dialysis stage than in those in the pre-dialysis stage (2.333 vs. 2.296, p = 0.001; 2.322 vs. 2.282, p = 0.002, respectively). Analysis of the structural covariance network revealed that the assortative coefficient was lower in patients with ESRD in the pre-dialysis stage than in healthy controls (-0.062 vs. -0.031, p = 0.029) and was higher in patients with ESRD in the post-dialysis stage than in those in the pre-dialysis stage (-0.002 vs. -0.062, p = 0.042).</p><p><strong>Conclusion: </strong>We observed differences in the cortical thickness and structural covariance networks before and after dialysis in patients with ESRD. This indicates that dialysis affects structural brain connectivity, contributing to the understanding of the pathophysiological mechanism of cognitive function alterations resulting from dialysis in patients with ESRD.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"28-36"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2024-09-26DOI: 10.1159/000540306
Laura Rosales Merlo, Xiaoling Ye, Hanjie Zhang, Brenda Chan, Marilou Mateo, Seth Johnson, Frank M van der Sande, Jeroen P Kooman, Peter Kotanko
{"title":"Novel Method to Monitor Arteriovenous Fistula Maturation: Impact on Catheter Residence Time.","authors":"Laura Rosales Merlo, Xiaoling Ye, Hanjie Zhang, Brenda Chan, Marilou Mateo, Seth Johnson, Frank M van der Sande, Jeroen P Kooman, Peter Kotanko","doi":"10.1159/000540306","DOIUrl":"10.1159/000540306","url":null,"abstract":"<p><strong>Introduction: </strong>Arteriovenous fistula (AVF) maturation assessment is essential to reduce venous catheter residence. We introduced central venous oxygen saturation (ScvO2) and estimated upper body blood flow (eUBBF) to monitor newly created fistula maturation and recorded catheter time in patients with and without ScvO2-based fistula maturation.</p><p><strong>Methods: </strong>From 2017 to 2019, we conducted a multicenter quality improvement project (QIP) in hemodialysis patients with the explicit goal to shorten catheter residence time post-AVF creation through ScvO2-based maturation monitoring. In patients with a catheter as vascular access, we tracked ScvO2 and eUBBF pre- and post-AVF creation. The primary outcome was catheter residence time post-AVF creation. We compared catheter residence time post-AVF creation between QIP patients and controls. One control group comprised concurrent patients; a second control group comprised historic controls (2014-2016). We conducted Kaplan-Meier analysis and constructed a Cox proportional hazards model with variables adjustment to assess time-to-catheter removal.</p><p><strong>Results: </strong>The QIP group comprised 44 patients (59 ± 17 years), the concurrent control group 48 patients (59 ± 16 years), the historic control group 57 patients (58 ± 15 years). Six-month post-AVF creation, the fraction of non-censored patients with catheter in place was 21% in the QIP cohort, 67% in the concurrent control group, and 68% in the historic control group. In unadjusted and adjusted analysis, catheter residence time post-fistula creation was shorter in QIP patients compared to either control groups (p < 0.001).</p><p><strong>Conclusion: </strong>ScvO2-based assessment of fistula maturation is associated with shorter catheter residence post-AVF creation.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"44-53"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2024-11-21DOI: 10.1159/000542469
Yupei Li, Mei Han, Mei Yang, Baihai Su
{"title":"Hemoperfusion with the HA330/HA380 Cartridge in Intensive Care Settings: A State-Of-The-Art Review.","authors":"Yupei Li, Mei Han, Mei Yang, Baihai Su","doi":"10.1159/000542469","DOIUrl":"10.1159/000542469","url":null,"abstract":"<p><strong>Background: </strong>Hemoperfusion with the HA330/HA380 cartridge has markedly evolved during the past decade and has thus been widely used in intensive care settings to treat critical or hyperinflammatory illnesses. Numerous clinical studies have demonstrated that HA330/HA380 hemoperfusion might mitigate systemic inflammatory response syndrome and organ dysfunction in ICU patients by removing inflammatory mediators and metabolic toxins from the blood. However, there is currently lacking a systematic evaluation on the safety and efficacy of HA330/HA380 hemoperfusion in intensive care settings.</p><p><strong>Summary: </strong>We searched the PubMed database, Chinese Clinical Trial Registry, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> for articles published from inception to June 20, 2024 (updated on September 10, 2024) to perform a state-of-the-art review of HA330/HA380 hemoperfusion in daily critical care practice. We discuss the basic technique characteristics and ex vivo investigations of the HA330/HA380 cartridge and summarize the latest clinical evidence regarding the use of HA330/HA380 hemoperfusion for the treatment of sepsis, severe COVID-19, cardiac surgery, acute pancreatitis, liver failure, and blunt trauma. Ex vivo studies suggest that the HA330/HA380 cartridge demonstrates satisfactory biocompatibility and substantial adsorption capacity for inflammatory cytokines, such as interleukin-6, interleukin-10, and tumor necrosis factor-α. Small-scale clinical studies indicate that HA330/HA380 hemoperfusion may help reduce plasma levels of inflammatory mediators, alleviate organ dysfunction, and improve survival in some critically ill patients with sepsis, severe COVID-19, acute pancreatitis, and blunt trauma.</p><p><strong>Key messages: </strong>(i) The HA330/HA380 cartridge contains abundant, coated, biocompatible sorbent beads made of styrene-divinylbenzene copolymers. (ii) HA330/HA380 hemoperfusion, with or without combined continuous renal replacement therapy, is a promising treatment option for some critically ill patients by removing proinflammatory mediators and alleviating organ dysfunction. (iii) The HA330/HA380 cartridge may adversely adsorb antibiotics, and appropriate antibiotic dosing adjustment and plasma drug level monitoring is recommended. (iv) There are currently numerous ongoing clinical trials evaluating the safety and efficacy of HA330/HA380 hemoperfusion in critically ill patients who develop sepsis or undergo cardiopulmonary bypass, which will certainly sharpen our future practice of HA330/HA380 hemoperfusion in ICU.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"122-137"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2025-02-12DOI: 10.1159/000543827
Jing Wen, Shen Zhan, Yuzhu Wang, Lihong Zhang, Han Li
{"title":"The Efficacy of Ultrasound-Guided Selective Nerve Block in the Endovascular Treatment of Arteriovenous Fistulas.","authors":"Jing Wen, Shen Zhan, Yuzhu Wang, Lihong Zhang, Han Li","doi":"10.1159/000543827","DOIUrl":"10.1159/000543827","url":null,"abstract":"<p><strong>Introduction: </strong>Delivering requisite anesthesia for endovascular treatment of dysfunctional arteriovenous fistulas (AVFs) under a targeted nerve block can achieve reasonable analgesia. We evaluated the efficacy and safety of ultrasound-guided selective nerve block (SNB) during percutaneous transluminal angioplasty (PTA) of dysfunctional arteriovenous access.</p><p><strong>Methods: </strong>Two hundred forty-six patients with dysfunctional radiocephalic AVF undergoing PTA were enrolled in this prospective, randomized controlled trial at the Department of Nephrology, Haidian Hospital, Peking University Third Hospital from June 1, 2022, to August 31, 2023. The patients were randomized into either the SNB group (SNB group, n = 123) or the local infiltration anesthesia group (LA group, n = 123). A visual analog scale (VAS) from no pain (= 0) to worst pain possible (= 10) was used to assess the pain intensity. Patient and operator satisfaction were graded from 0 to 2: 0, not satisfied at all; 1, partially satisfied; 2, satisfied. The AVF patency at 1 and 3 months after PTA was also evaluated.</p><p><strong>Results: </strong>Compared with the LA group, the SNB group had significantly lower VAS scores (Z = -7.193, p < 0.001) and required fewer additional anesthetics during the operation (χ2 = -4.847, p = 0.028). Patient and operator satisfaction were significantly higher in the SNB group (p < 0.05). Eight patients in the SNB group encountered grade 3 motor paralysis after the operation, and they all recovered within 60 min. There was no significant difference in primary patency rates of the fistula between the two groups either at 1 month or 3 months after the operation (p > 0.05).</p><p><strong>Conclusion: </strong>Compared with LA, ultrasound-guided SNB has advantages over the LA during endovascular treatment of dysfunctional hemodialysis (HD) fistulas. It can provide safe and efficient analgesia with excellent procedural satisfaction in HD patients.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"240-249"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2025-04-21DOI: 10.1159/000545703
Ami M Patel, Nazli Atefi, Jagman Chahal, Abutaleb Ahsan Ejaz
{"title":"Mid-Range Dialysate Flow and Adequacy of Dialysis.","authors":"Ami M Patel, Nazli Atefi, Jagman Chahal, Abutaleb Ahsan Ejaz","doi":"10.1159/000545703","DOIUrl":"10.1159/000545703","url":null,"abstract":"<p><strong>Introduction: </strong>The primary objective was to investigate the efficiency of a fully integrated, hemodialysis machine that utilizes mid-range dialysate flow rate of 300 mL/min in the acute hospital setting.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center pilot study. All veterans with end-stage kidney disease or dialysis-dependent acute kidney injury, who completed ≥3 h of hemodialysis and had pre-dialysis blood urea nitrogen (BUN) >20 mg/dL with available post-dialysis BUN from February 2023 to June 2023 were included. Urea reduction ratio (URR) and single-pool Kt/V were compared between groups with varying dialyzer sizes and duration of treatment.</p><p><strong>Results: </strong>Fifty-nine dialysis sessions were included for analysis. Mean Kt/V and URR for the full cohort were 1.26 ± 0.04 and 60.8 ± 7.3%, respectively. The percentage of sessions achieving minimum adequate clearance per Kt/V and URR criteria were 50.6% and 32.5%, respectively. In the subgroup analysis of dialysis sessions of different filter size (Optiflux™ F160NR or F180NR dialyzers) and varying duration (3, 3.5, 4 h), the percentage of sessions achieving minimum adequate Kt/V in the F160/3.5 h, F180/3.5 h and F180/4 h groups were 44%, 50%, and 58.8%, respectively.</p><p><strong>Conclusion: </strong>The restriction of QD to 300 mL/min may compromise adequacy of dialysis in acute care setting. This may be mitigated by prolonging session times, albeit at the expense of higher resource utilization, and improving the QD:QB ratio. Further studies in a larger hospital cohort are necessary to elucidate these issues.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"347-352"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2025-03-11DOI: 10.1159/000545179
Benedetta Savasta, Martina Giacco, Federico Pappalardo
{"title":"Reply to Brozat et al. on \"Albumin and Platelet Loss during the Application of CytoSorb® in Critically Ill Patients: A post hoc Analysis of the CytoSOLVE Trial\".","authors":"Benedetta Savasta, Martina Giacco, Federico Pappalardo","doi":"10.1159/000545179","DOIUrl":"10.1159/000545179","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"364-365"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood PurificationPub Date : 2025-01-01Epub Date: 2025-04-03DOI: 10.1159/000545122
Abutaleb Ahsan Ejaz, Ami M Patel, Maria C Browne, Evan I Fisher, Kamyar Pournazari, Stephen L Seliger
{"title":"Complexities in Interpretation of Elevated Serum Creatinine.","authors":"Abutaleb Ahsan Ejaz, Ami M Patel, Maria C Browne, Evan I Fisher, Kamyar Pournazari, Stephen L Seliger","doi":"10.1159/000545122","DOIUrl":"10.1159/000545122","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"366-372"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Protein-Bound Uremic Toxins Removal with Medium Cut-Off Membranes: A Pilot Study Showing No Superiority over High-Flux Dialysis.","authors":"Francisca Aranda, Bárbara Segovia-Hernández, Constanza Verdugo, Cristian Pedreros-Rosales, Armando Rojas, Gonzalo Ramírez-Guerrero","doi":"10.1159/000546721","DOIUrl":"10.1159/000546721","url":null,"abstract":"<p><strong>Introduction: </strong>Protein-bound uremic toxins such as advanced glycation end products (AGEs) are poorly cleared by conventional dialysis. Medium cut-off (MCO) membranes have been proposed to enhance their removal, but clinical evidence remains limited.</p><p><strong>Methods: </strong>In this prospective pilot study, 8 maintenance hemodialysis patients were assigned to receive a single dialysis session using either an MCO or high-flux (HF) membrane. Serum levels of N-carboxymethyllysine (CML), soluble receptor for AGEs (sRAGE), and prolactin were measured pre- and post-dialysis. Reduction ratios corrected for hemoconcentration (RRc) were compared between groups.</p><p><strong>Results: </strong>The median RRc for CML was similar between MCO (36.9%) and HF (35.6%) membranes (p = 0.686). sRAGE reduction was lower with MCO membranes (21.8% vs. 41.9%, p = 0.114), while prolactin clearance was slightly higher (58.1% vs. 50.9%, p = 0.486). No statistically significant differences were observed.</p><p><strong>Conclusion: </strong>MCO membranes did not demonstrate superior removal of protein-bound toxins compared to HF membranes in this pilot study. These findings highlight the need for alternative strategies, such as adsorption, and larger studies to define the clinical utility of MCO technology.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"513-516"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}