Clinical Effectiveness
Compared with high-flux membranes, the MCO membrane increased the elimination of large middle molecules, resulting in decreased predialysis solute concentrations of solutes ranging between 11.8 and 58 kDa. Although dialysis membrane did not normalize serum concentrations of these solutes, the net effect of enhanced clearance within the large middle-molecule spectrum could explain the range of beneficial clinical effects reported to date.1
Importance of clinical effectiveness
Uremic toxins exhibit a wide range of physiochemical properties leading to diverse molecular and cellular level effects that contribute to morbidity and mortality among patients with end-stage renal disease.1
Large-middle molecules comprised a diverse group of biomarkers including cytokines, adipokines, hormones and other proteins that are implicated in chronic inflammation, cardiovascular disease and secondary immunodeficiency.2
Ciceri P, Tettamanti G, Galassi A, et al. Pro-calcifying analysis of uraemic serum from patients treated with medium cut-off membrane in a prospective, cross-over study.
The MCO membrane might decrease uremic serum pro-calcifying and necrotic effects through albumin loss without any clinical signs of hypoalbuminemia.3
Willy K, Girndt M, Voelkl J, et al. Expanded hemodialysis therapy of chronic hemodialysis patients prevents calcification and apoptosis of vascular smooth muscle cells in vitro
Expanded hemodialysis therapy reduced in vitro markers of calcification, which could mean a reduction in vascular calcification and corresponding cardiovascular mortality in patients with chronic kidney disease.4
Korucu B, Yeter H, Gonen S, Kursat Derici M, Ronco C, Derici U. Impact of medium cut-off membranes on S100A12 and soluble receptor for advanced glycation end products.
This study suggests that prolonged use of MCO membrane dialyzer is associated with better S100A12-sRAGE profiles than low-flux and high-flux dialyzers.5
Kim YG, Lee SH, Jung SW, et al. The medium cut-off membrane does not lower protein-bound uremic toxins
Clearance of the protein-bound uremic toxins (PBUTs) indoxyl sulfate (IS) and p-cresyl sulfate (pCS) was not different across the three different dialysis methods (HF-HD, post-OL-HDF, MCO-HD).6
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References
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Kandi M, Brignardello-Petersen R, Couban R, Wu C, Nesrallah G. Effects of medium cut-off versus high-flux hemodialysis membranes on biomarkers: a systematic review and meta-analysis. Can J Kidney Health Dis. 2022:9;1-15.
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Wolley M, Jardine M, Hutchison CA. Exploring the clinical relevance of providing increased removal of large middle molecules. Clin J Am Soc Nephrol. 2018;13:805-814.
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Ciceri P. Tettamanti G, Galassi A, et al. Pro-calcifying analysis of uraemic serum from patients treated with medium cut-off membrane in a prospective, cross-over study. Clinical Kidney Journal. 2021;14(7):1798-1807.
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Willy K. Girndt M, Voelkl J, et al. Expanded Haemodialysis therapy of chronic haemodialysis patients prevents calcification and apoptosis of vascular smooth muscle cells in vitro. Blood Purif. 2018;45:131-138.
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Korucu B, Veter H, Gonen S, Kursat Derici M. Ronco C, Derici U. Impact of medium cut-off membranes on S1 OOA 12 and soluble receptor for advanced glycation end products. Semin Dial. 2023;36(3):193-200.
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Kim YG, Lee SH, Jung SW, et al. The medium cut-off membrane does not lower protein-bound uremic toxins. Toxins. 2022;14:779.