SP418THE USE OF MEDIUM CUT-OFF (MCO) MEMBRANES IN CHRONIC DIALYSIS PATIENTS MODULATES INFLAMMATION: LESSONS FROM A RANDOMIZED CLINICAL TRIAL

Abstract

Introduction and Aims: Cardiovascular mortality in chronic dialysis patients is greatly increased and relates to chronic microinflammation. The purpose of this randomized clinical trial was to assess whether the use of a novel Medium‐Cutoff membrane with better permeability for molecules up to 45 kDa provides better clearance of middle sized molecules and hence modulates inflammation. Methods: 50 patients were dialyzed with MCO (MCO‐Ci 400, Gambro, Germany) and conventional high‐flux (HF) membranes (Revaclear 400, Gambro, Germany) for four weeks following a randomized cross‐over design. After the second phase, another 12‐ week‐period was conducted to test for long‐term effects. Serum samples were tested for cytokine concentrations. Expression of TNF‐α and IL‐6 mRNA in leukocytes was quantitatively assayed by RT‐PCR. The primary and secondary endpoints were analysed using Generalized Estimating Equations (GEE) in a linear model to adjust for inter subject correlation. Support was granted by the German Federal Ministry of Education and Research (FKZ 13N11796‐99). Results: The primary end point mRNA content of TNF‐alpha and IL‐6 in leukocytes was reduced to a higher degree and significantly better after 4 weeks on MCO compared to HF membranes ( p<0.001). Soluble TNF Receptor I and Free Light Chains were reduced significantly better with MCO ( p<0.05). After a significant drop after four weeks of MCO dialysis, albumin concentrations stabilized after 12 weeks. Conclusions: The use of MCO membranes in chronic dialysis patients modulates inflammation in dialysis patients. Markers of inflammation were significantly altered. These results encourage further investigations with longer treatment periods and clinically relevant endpoints. (Table Presented).