EFFECT OF HIGH-FLUX VERSUS LOW-FLUX DIALYSIS MEMBRANES ON CARDIOVASCULAR RISK IN HEMODIALYSIS PATIENTS

Introduction:

Patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (HD) have a high risk of cardiovascular morbidity and mortality. The most effective and best tolerated HD treatment can improve clinical outcomes in this patient population. In particular, the dialyzer used in HD treatment is one of the important determinants of the effectiveness of dialysis. HD using high-flux dialysis membrane can clear more middle molecular weight uremic toxins than HD using low-flux dialysis membrane. The main purpose of this study is to find out the effect of high-flux versus low-flux dialysis membranes on cardiovascular risk in hemodialysis patients.

Methods:

It was a prospective, hospital based, interventional and randomized comparative study. Hemodialysis patients attending the hemodialysis unit at No. (1) Defence Services General Hospital were randomized into two groups; hemodialysis with low-flux or high-flux dialysis membrane for six consecutive months. In the study period from October 2017 to June 2019, 7 out of 53 patients were dropped out due to deaths, transplants and absence of follow-up. So, total 46 patients were completed in this study for statistical analysis.

Results:

Forty-six patients (24 low-flux, 22 high-flux) completed the six-month study. The study included 46 patients, 23 males and 23 females. Mean age was 46 ± 9.97 years and mean HD duration was 19.24 ± 13.19 months.

Clinical, biochemical, and echocardiographic data were evaluated at the baseline and after six months of hemodialysis during the study.

During the study period, the mean Kt/V was 1.08 ± 0.15 in low-flux and 1.20 ± 0.28 in high-flux membrane dialysis. Therefore, these differences were statistically significant (p=0.026). The mean URR was 59.69 ± 5.49 in low-flux and 62.28 ± 8.04 in high-flux membrane dialysis, which these differences were not statistically significant (p= 0 .160).

There were no statistically significant differences between high-flux and low-flux dialysis group for serum C-reactive protein, albumin, hemoglobin, calcium, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol and uric acid. The serum phosphate was lower at the end of high-flux treatment. The mean difference was (2.06 ± 0.52 mmol/l versus 2.59 ± 0.65 mmol/l) with statistical significance at p value 0.004.

The main abnormality on echocardiographic examination was hypertrophy of left ventricle with diastolic dysfunction in both groups. The magnitude of echocardiographic improvements in high-flux group were modest and only isovolumic relaxation time and cardiac output reached the statistically significant level (p = 0.040 and p = 0.007 respectively).

Conclusions:

This study showed that dialysis with the high-flux membrane improved not only dialysis adequacy but also biochemical and echocardiographic outcomes. Therefore, dialysis with a high‑flux membrane may decrease cardiovascular risk to some extent.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.