The Medium Cut-Off Membrane Does Not Lower Protein-Bound Uremic Toxins

Yang Gyun Kim; Sang Ho Lee; Su Woong Jung; Gun Tae Jung; Hyun Ji Lim; Kwang Pyo Kim; Young-Il Jo; KyuBok Jin; Ju Young Moon

doi:10.3390/toxins14110779

The Medium Cut-Off Membrane Does Not Lower Protein-Bound Uremic Toxins

Toxins (Basel). 2022 Nov 10;14(11):779. doi: 10.3390/toxins14110779.

Authors

Yang Gyun Kim¹, Sang Ho Lee¹, Su Woong Jung¹, Gun Tae Jung², Hyun Ji Lim², Kwang Pyo Kim^{2

3}, Young-Il Jo⁴, KyuBok Jin⁵, Ju Young Moon¹

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul 05278, Korea.
² Department of Biomedical Science and Technology, Kyung Hee Medical Science Research Institute, Kyung Hee University, Seoul 02453, Korea.
³ Department of Applied Chemistry, Institute of Natural Science, Global Center for Pharmaceutical Ingredient Materials, Kyung Hee University, Yongin 17104, Korea.
⁴ Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul 05029, Korea.
⁵ Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsang Hospital, Keimyung University Kidney Institute, Daegu 42601, Korea.

Abstract

The accumulation of protein-bound uremic toxins (PBUT) is associated with increased cardiovascular outcomes in patients on dialysis. However, the efficacy of PBUT removal for a medium-cutoff (MCO) membrane has not been clarified. This study was designed to assess the efficacy of PBUT clearance according to dialysis modalities. In this prospective and cross-over study, we enrolled 22 patients who received maintenance hemodiafiltration (HDF) thrice weekly from three dialysis centers. The dialysis removal of uremic toxins, including urea, beta 2-microglobulin (B2MG), lambda free light chain (λ-FLC), indoxyl sulfate (IS), and p-cresyl sulfate (pCS), was measured in the 22 patients on high-flux HD (HF-HD), post-dilution online HDF (post-OL-HDF), and MCO-HD over 3 weeks. The average convection volume in post-OL-HDF was 21.4 ± 1.8 L per session. The reduction rate (RR) of B2MG was higher in post-OL-HDF than in MCO-HD and HF-HD. The RR of λ-FLC was the highest in MCO-HD, followed by post-OL-HDF and HF-HD. The dialysate albumin was highest in MCO-HD, followed by post-OL-HDF and HF-HD. Post-dialysis plasma levels of IS and pCS were not statistically different across dialysis modalities. The total solute removal and dialytic clearance of IS and pCS were not significantly different. The clearance of IS and pCS did not differ between the HF-HD, post-OL-HDF, and MCO-HD groups.

Keywords: hemodiafiltration; indoxyl sulfate; medium-cutoff; p-cresyl sulfate; protein-bound uremic toxin.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Over Studies
Hemodiafiltration*
Humans
Indican
Prospective Studies
Renal Dialysis
Uremic Toxins*

Substances

Uremic Toxins
MCO
Indican

Grants and funding

This work is supported by the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT the Ministry of Trade Industry and Energy the Ministry of Health and Welfare, and the Ministry of Food and Drug Safety) (Project Number: 1711138434, KMDF_PR_20200901_0207) (NTIS, KMDF-RnD KMDF_PR_20200901_0207).