Assessment of subjective and hemodynamic tolerance of different high-and low-flux dialysis membranes in patients undergoing chronic intermittent hemodialysis: A randomized controlled trial

Clinical experience and experimental data suggest that intradialytic hemodynamic profiles could be influenced by the characteristics of the dialysis membranes. Even within the worldwide used polysulfone family, intolerance to specific membranes was occasionally evoked. The aim of this study was to compare hemodynamically some of the commonly used polysulfone dialyzers in Switzerland. We performed an open-label, randomized, cross-over trial, including 25 hemodialysis patients. Four polysulfone dialyzers, A (Revaclear high-flux, Gambro, Stockholm, Sweden), B (Helixone high-flux, Fresenius), C (Xevonta high-flux, BBraun, Melsungen, Germany), and D (Helixone low-flux, Fresenius, Bad Homburg vor der Hohe, Germany), were compared. The hemodynamic profile was assessed and patients were asked to provide tolerance feedback. The mean score (+/- SD) subjectively assigned to dialysis quality on a 1-10 scale was A 8.4 +/- 1.3, B 8.6 +/- 1.3, C 8.5 +/- 1.6, D 8.5 +/- 1.5. Kt/V was A 1.58 +/- 0.30, B 1.67 +/- 0.33, C 1.62 +/- 0.32, D 1.45 +/- 0.31. The low- compared with the high-flux membranes, correlated to higher systolic (128.1 +/- 13.1 vs. 125.6 +/- 12.1mmHg, P<0.01) and diastolic (76.8 +/- 8.7 vs. 75.3 +/- 9.0mmHg; P<0.05) pressures, higher peripheral resistance (1.44 +/- 0.19 vs. 1.40 +/- 0.18sxmmHg/mL; P<0.05) and lower cardiac output (3.76 +/- 0.62 vs. 3.82 +/- 0.59L/min; P<0.05). Hypotension events (decrease in systolic blood pressure by >20mmHg) were 70 with A, 87 with B, 73 with C, and 75 with D (P<0.01 B vs. A, 0.05 B vs. C and 0.07 B vs. D). The low-flux membrane correlated to higher blood pressure levels compared with the high-flux ones. The Helixone high-flux membrane ensured the best efficiency. Unfortunately, the very same dialyzer correlated to a higher incidence of hypotensive episodes.