K KAMESHWAR1, M DAMASIEWICZ1,2, K POLKINGHORNE1,2, SE FOO1, M UHE1, HK SIN1,3, PG KERR1,2
1Department of Nephrology, Monash Health, Clayton, Melbourne, Australia, 2Department of Medicine, Monash University, Clayton, Melbourne, Australia, 3Department of Nephrology, Kwong Was Hospital, Yau Ma Tei, Hong Kong
Aim: To compare properties of a novel asymmetrical cellulose triacetate (ATA) dialyser (Solacia 190-H, Nipro) to a commonly used high-flux polysulfone dialyser (FX-80, Fresenius) in patients undergoing long-hour (>7 hours) haemodialysis (HD).
Background: The ATA membrane is highly porous and less prone to performance degradation, compared to a conventional high-flux membrane, potentially resulting in enhanced clearance of middle and large-middle molecules, along with protein bound solutes.
Method: 10 long-hour home HD patients were included in this randomised cross-over trial. Patients were randomised to 4 weeks of either the 190-H or FX-80 dialyser with subsequent cross-over to the other. The removal of small (urea, phosphate and creatinine), middle and large-middle molecules (beta-2 microglobulin [B2M], indoxyl sulfate [IS], albumin) and markers of inflammation (interleukin-6 [IL-6], malondialdehyde-modified low density lipoprotein [MDA-LDL]), were evaluated during the mid-week dialysis session of the fourth week of each dialyser sequence. All results are expressed as mean differences in corresponding reduction ratios (RR) between the FX-80 and 190-H dialysers after 8 hours of dialysis.
Results: There was no significant difference in reduction in clearance of small molecules, with a RR difference for urea -2.43 (p=0.19), creatinine – 1.82 (p=0.28) and phosphate – 2.61 (p=0.55). Similarly, there was no difference in clearance of middle and large-middle molecules with a RR difference for B2M 2.63 (p=0.22), IS 2.48 (p=0.69) and albumin – 0.15 (p=0.96). There was also no difference in expression of inflammatory markers with RR for IL-6 18.8 (p=0.44) and MDA-LDL – 8.0 (p=0.3).
Conclusion: Our study did not demonstrate a difference in clearance of small, middle and large-middle molecules, nor the expression of markers of inflammation between the FX-80 and H-190 dialysers.
Currently an Advanced Trainee in Nephrology (final year) and General Medicine, based in Victoria.