Comparison of the Removal of Uremic Toxins With Medium Cut-off and Super High-flux Vitamin E-coated Dialyzers

NCT05610683 | Completed

• 1 other identifier: E-FLUX
• Study Type: interventional
• Target: 41
• Locations: 1 country
• Sites: 1

Brief Summary

End-stage renal disease (ESRD) induces an accumulation of uremic toxins responsible for increased morbidity and mortality. These toxins cover a wide range of molecules, classified according to their molecular weight as small-size (\< 500 Da), middle-size (500 Da-60 kDa), and protein-bound toxins. Specific complications have been associated with the accumulation of middle-size toxins, including beta2-microglobulin (12 kDa), myoglobin (17 kDa), prolactin (23 kDa), alpha1-microglobulin (33 kDa), alpha1-glycoprotein (44 kDa), kappa (22 kDa) and lambda (45 kDa) free light chains (FLC). Moreover, mediators of oxidative stress such as asymmetric dimethylarginine, malondialdehyde, oxidative-LDL and inflammatory cytokines such as Interleukin-6 (IL)-6, IL1-β, TNF-α have been involved in atherosclerosis, malnutrition, cardiovascular events and mortality. Hemodialysis (HD) remains the main standard modality of renal replacement therapy in ESRD. In the past decade, low-flux hemodialysis was most commonly used, providing effective clearance of small solutes through diffusion, but negligible clearance of middle molecules. This limitation was insufficiently improved by the development of high-flux (HF) dialyzers due to their cut-off pores size values of approximately 15-20 kDa. In fact, most of middle molecules cannot be efficiently removed by HF-HD because of their molecular radii larger than that of membrane pores. Thus, HF dialyzers were used in post dilution on-line hemodiafiltration (OL-HDF) mode with high convection volumes and achieved greatest clearance of middle molecules. However, OL-HDF is generally not available in most HD centers and needs additional hardware technology. Therefore, several super high-flux (SHF) dialyzers integrating higher cut-off size pore value and achieving Beta2-microglobulin clearance \> 70 ml/min were developed for HD mode. These SHF dialyzers used in HD (SHF-HD) provides similar middle molecules depuration compared to OL-HDF. The recently developed medium cut-off (MCO) dialyzer (Theranova 500™, Baxter healthcare Corporation Deerfield, USA; surface area 2 m², ultrafiltration coefficient: 59 ml/h/mmHg) differs from conventional HF membranes by higher and controlled porosity resulting in a steep sieving curve with a cut-off value approaching that of albumin. MCO-HD has demonstrated efficient depuration of middle uremic toxins as compared to HF-HD, similar to that of OL-HDF. MCO-HD and SHF-HD are two new large pore size dialyzers currently used nowadays in HD. In addition, the interaction between blood and membrane surface play a key role in generating oxidative stress and inflammation. Antioxidants such as vitamin E work by inhibiting LDL oxidation and by limiting cellular response to oxidized LDL. In HD patients, vitamin E may be integrated as a part of the HD procedure in the form of bioreactive dialysis membranes, in which the blood surface has been modified with alpha-tocopherol. Dialysis with vitamin E-coated membranes has been associated with an improvement in biocompatibility including circulating lipid peroxidation biomarkers and cytokine induction. In small studies, vitamin E coated dialyzers have been associated with reduced red blood count fragility and improvements in erythropoietin resistance index and erythropoietin requirements in HD. VieX (Polysulfone, surface area: 2.1 m², sterilization gamma, ultrafiltration coefficient: 104.3 ml/h/mmHg, Asahi Kasei Medical, Japan), a novel SHF vitamin E-coated (SHVE) dialyzer, which has larger pore size than HF dialyzer, might provide higher middle molecules removal and biocompatibility improvement. The aim of the present study was to compare the efficiency of the SHFVE dialyzer (VieX™) versus the MCO dialyzer (Theranova 500™) on the removal of beta2-microglobulin and other middle molecules in a non-inferiority fashion, and their respective effects on inflammation, oxidative stress and biocompatibility parameters.

Conditions

End Stage Renal Disease (ESRD)

Keywords

super high-flux hemodialysis; medium cut-off hemodialysis; beta2-microglobulin

Outcome Measures

Primary Outcomes (1)

• Beta2-microglobulin reduction ratio (RR) after 3 months of SHFVE-HD and MCO-HD in a non-inferiority fashion.

  3 months

Study Arms (2)

SHFVE-HD group

EXPERIMENTAL

Hemodialysis sessions using the VieX™ (Polysulfone, surface area: 2.1 m², sterilization gamma, ultrafiltration coefficient: 104.3 ml/h/mmHg, Asahi Kasei Medical, Japan).

Device: Hemodialysis sessions using SHFVE dialyzer (VieX™) or the MCO (Theranova 500™) dialyzer

MCO-HD group

EXPERIMENTAL

Hemodialysis sessions using the Theranova 500™ (Baxter healthcare Corporation Deerfield, USA; surface area 2 m², ultrafiltration coefficient: 59 ml/h/mmHg).

Device: Hemodialysis sessions using SHFVE dialyzer (VieX™) or the MCO (Theranova 500™) dialyzer

Interventions

Hemodialysis sessions using SHFVE dialyzer (VieX™) or the MCO (Theranova 500™) dialyzer DEVICE

Patients will receive thrice weekly 4 hours hemodialysis sessions during 3 months

MCO-HD group; SHFVE-HD group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Signed informed consent
• Age ≥ 18 years
• Patients established on HF-HD trice weekly four hour-sessions for at least 3 months

You may not qualify if:

• Malabsorption syndrome, active malignant disease or other critical illnesses and any ongoing condition that may interfere with inflammatory parameters (baseline C-Reactive Protein \>40 mg/l)
• Pregnant or breast feeding women
• Any uncontrolled medical condition, psychiatric disorder or biological abnormality that might interfere with subject's participation or ability to sign an informed consent.
• Significant residual kidney function as defined by an urine output \> 500 mL.

Sponsors & Collaborators

• Poitiers University Hospital: lead
• Hemotech: collaborator

Study Sites (1)

CHU de Poitiers

Poitiers, 86000, France

Location

Related Publications (1)

• Belmouaz M, Cogne E, Joly F, Duthe F, Desport E, Martin C, Hauet T, Giraud S, Lemarie E, Durocher L, Bridoux F. Effects of super high-flux vitamin E-coated and medium cut-off dialyzers on uremic toxins removal and biocompatibility: the E-FLUX randomized controlled study. Clin Kidney J. 2025 Apr 11;18(5):sfaf106. doi: 10.1093/ckj/sfaf106. eCollection 2025 May.

  PMID: 40342620 DERIVED

MeSH Terms

Conditions

Kidney Failure, Chronic

Condition Hierarchy (Ancestors)

Renal Insufficiency, Chronic; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The E-FLUX is a prospective randomized open-label cross over study. The study will include 38 patients established on HF-HD randomly assigned to receive either 3 months of SHFVE-HD followed by 3 months of MCO-HD, or vice versa.

Study Record Dates

• First Submitted: October 27, 2022
• First Posted: November 9, 2022
• Study Start: June 14, 2023
• Primary Completion: January 31, 2024
• Study Completion: January 31, 2024
• Last Updated: April 4, 2024

Record last verified: 2024-04

Locations

FR (1)