Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialysers in conventional haemodialysis and online haemodiafiltration

Background: Online haemodiafiltration (OL-HDF) has been shown to reduce all-causemortality versus conventional haemodialysis (HD); however, it is not always available. In these situations, a novel class ofmembranes with a higher pore size, mediumcut-off (MCO) dialysers, could be promising. The aimof this study is to evaluate the efficacy of an MCO dialyser in the removal of small andmedium-sizemolecules and compare it with standard high-flux (HF) dialysers in HD and OL-HDF. Methods: In this crossover study, 18 prevalent HD patients were studied in three single mid-week dialysis treatments during three consecutive weeks as follows: first week with OL-HDF with a standard HF dialyser, second week with conventional HD with a standard HF dialyser and third week with conventional HD with an MCO dialyser. Reduction ratios (RRs) of different-sized molecules and albumin losses were collected for the different dialysers. Results: MCO HD provided a greater reduction of middle and larger middle molecules compared with standard HF HD [rate reduction (RR) beta 2-microglobulin 74.7% versus 69.7%, P = 0.01; RR myoglobin 62.5% versus 34.3%, P = 0.001; RR prolactin 60% versus 32.8%, P = 0.001; RR a1-glycoprotein 2.8% versus -0.1%, P = 0.01]. We found no difference in the clearance of small and larger middle molecules comparing MCO HD with OL-HDF. Albumin losses were 0.03 g/session with MCO HD and 3.1 g/session with OL-HDF (P = 0.001). Conclusion: MCO HD is superior to standard HF HD in the removal of middle and larger middle molecules and it is not inferior to OL-HDF in the clearance of small and larger middle molecules. Thus it could be an alternative in patients in which it is not possible to perform OL-HDF.