EFFECT OF HEMODIALYSIS WITH MEDIUM CUT-OFF vs. HIGH-FLUX MEMBRANES ON ENDOTHELIAL FUNCTION OF PATIENTS WITH CHRONIC KIDNEY DISEASE.

BACKGROUND:Endothelial dysfunction (ED) is considered a marker of vascular complications, especially in patients with end-stage kidney disease (ESKD). Inflammation and the uremic state contribute to ED in patients undergoing hemodialysis (HD). Recently, the medium cut-off (MCO) dialysis membrane has been proposed to efficiently remove inflammatory cytokines and large middle-sized uremic toxins, with the potential effect to improve endothelial function. This study aims to compare the effect of dialysis with MCO or high-flux membranes on the endothelial function of patients on chronic HD. METHODS:A prospective, randomized, crossover study in which 32 patients with ESKD were dialyzed for 12 weeks with each membrane, including a 4-week washout period between treatments. Endothelial function was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound at weeks 1, 12, 16, and 28. RESULTS:The population consisted of 59% men, 52.7±13.4 years, 16% non-black, on HD for 8.8 (4.1-15.1) years, 72% with arteriovenous fistula. Hypertension was the most common etiology of CKD and 34% of patients had previous cardiovascular disease. Patients were grouped, regardless of treatment sequence, into MCO or high-flux groups, since no carry-over (p=0.634) or sequence (p=0.998) effects were observed in the FMD assessment. The ANOVA model with repeated measures showed no effects of treatment (p=0.426), time (p=0.972) or interaction (p=0.413) in the comparison of FMD, between the MCO and high flux groups. CONCLUSION:Dialysis performed with MCO, or high-flux membranes had no influence on endothelial function in patients undergoing HD. However, a trend towards increased FMD was observed with the use of the MCO membrane.