New High-Cutoff Dialyzer Allows Improved Middle Molecule Clearance without an Increase in Albumin Loss: A Clinical Crossover Comparison in Extended Dialysis

作者：Schmidt Julius J; Hafer Carsten; Clajus Christian; Hadem Johannes; Beutel Gernot; Schmidt Bernhard M W; Kielstein Jan T^*

来源：Blood Purification, 2012, 34(3-4): 246-252.

DOI：10.1159/000342631

• Acute kidney injury
• Middle molecules
• Extended dialysis
• Albumin loss

Background: Accumulation of middle molecules is thought to have adverse effects in patients with acute kidney injury (AKI). Elimination of middle molecules by non-convective means, i.e. hemodialysis, remains difficult. The aim of the study was to investigate the removal characteristics of a new high permeability membrane in AKI patients undergoing extended dialysis (ED). Patients and Methods: We performed a prospective, crossover study comparing the EMiC2 dialyzer (1.8 m(2), FMC, Germany) and AV 1000S (1.8 m(2), FMC) in 11 critically ill patients with AKI. beta(2)-Microglobulin, cystatin c, creatinine, and urea were measured before and after 0.5, 5.0 and 10 h of ED. Serum reduction ratios, dialyzer clearances, and mass in the total collected dialysate were determined. Results: Dialyzer clearance of beta(2)-microglobulin (EMiC2: 52 +/- 1.7 ml/min, AV 1000S: 41.7 +/- 1.5 ml/min, p = 0.0002) and cystatin c (EMiC2: 47.2 +/- 1.2 ml/min, AV 1000S: 34.2 +/- 2.3 ml/min, p %26lt; 0.0001) was markedly different, as was the reduction of serum levels of beta(2)-microglobulin (EMiC2: 54.3 +/- 3.6%, AV 1000S: 39.1 +/- 4.5%, p = 0.025) and cystatin c (EMiC2: 38.9 +/- 2.6%, AV 1000S: 28.0 +/- 3.9%, p = 0.043). Additionally, we observed a higher total amount of these substances in the collected dialysate. There was no significant difference in the total amount of albumin eliminated per treatment. Conclusion: The new EMiC2 dialyzer enhances removal of middle molecules without an increase in albumin loss. The clinical relevance of this finding needs to be determined.

• 出版日期2012