Comparison of four medium cut-off dialyzers

BACKGROUND: Recently, several pharmaceutical companies have developed new medium cut-off (MCO) dialyzers for expanded hemodialysis (HDx). This study aimed to compare the safety and efficacy of four MCO dialyzers, against each other and versus high-flux hemodialysis (HD) and post-dilution hemodiafiltration (HDF). METHODS: A prospective study was carried out on 23 patients who underwent six dialysis sessions: two sessions with the FX80 Cordiax in HD and HDF, and four HDx sessions with the Phylther 17-SD, Vie-18X, Elisio HX19 and Theranova 400 dialyzers. The reduction ratios (RRs) of urea, creatinine, β(2)-microglobulin, myoglobin, kappa free immunoglobulin light chain (κFLC), prolactin, α(1)-microglobulin, α(1)-acid glycoprotein, lambda (λFLC) and albumin were compared. Dialysate albumin loss was also measured. RESULTS: The differences in efficacy between the evaluated dialyzers were minimal in small molecules and even up to the size of β(2)-microglobulin. The main differences were found between myoglobin, κFLC, prolactin, α(1)-microglobulin and λFLC RRs, in which all four MCO dialyzers, with similar efficacy, were clearly superior to HD and slightly inferior to HDF treatment. Albumin losses in the dialysate with HD dialyzers were <1 g and between 1.5 and 2.5 g in HDx and HDF. The global removal score values were similar in all four HDx treatments, and again significantly higher than those with HD. CONCLUSIONS: The results of the four MCO dialyzers evaluated in this study showed good efficiency, with no significant performance differences between them while being completely safe in terms of albumin loss. Likewise, the study confirms the superiority of HDx over high-flux HD with an efficacy close to that of post-dilution HDF.