Efficiency Analysis Between ELISIO High-Flux and Super High-Flux Dialyzers in Chronic Hemodialysis

Abstract

Conventional high-flux hemodialysis and new technologies, including super high-flux dialyzers and hemodiafiltration, have significantly improved the clearance of uremic toxins and inflammatory cytokines, as well as hemodynamic stability. Objectives: To assess the efficiency of the new Nipro ELISIO-HX (super high-flux) dialyzer in comparison with the high-flux Nipro ELISIO-H dialyzer in a cohort of patients undergoing chronic hemodialysis.

This was an open-label, prospective, two-arm crossover study designed to evaluate the removal rate of Beta-2 microglobulin, parathyroid hormone, and kappa and lambda light chains between the ELISIO H and ELISIO HX. The study included adults over 18 years of age who had been on hemodialysis for more than 3 months, had a hematocrit level above 30%, and had established vascular access. Patients were randomly assigned to two groups: Alpha (n=6) and Beta (n=7). Both groups underwent three weekly hemodialysis sessions with each filter, utilizing a crossover design. All sessions were performed with a blood flow rate of 300 ml/hour and a duration of 4 hours. Blood samples were collected before and after dialysis during the second session of each week. The study protocol was approved by the International Ethics Committee in Spain. 

The mean differential value of parathyroid hormone (pre- and post-dialysis) was 177.15 pg/mL with ELISIO H versus 201.23 pg/mL with ELISIO HX (p = 0.74). The mean differential value of lambda chain was 16.78 mg/L with ELISIO H versus 101.38 mg/L with ELISIO HX (p = 0.14). The mean differential value of albumin was -0.17 mg/dL with ELISIO H versus -0.37 mg/dL with ELISIO HX (p = 0.14). In the diabetic patient subgroup, the mean differential value of albumin was -0.23 mg/dL with ELISIO H versus -0.65 mg/dL with ELISIO HX (p = 0.04), with no episodes of hypotension or hemodynamic instability observed in either group. The other parameters analyzed did not show statistically significant differences between the dialyzers.

The magnitude of the sieving effect for parathyroid hormone and lambda light chains was greater in the group using the super high-flux dialyzer, ELISIO HX. Additionally, the use of ELISIO HX demonstrates a lower loss of albumin, particularly in diabetic patients.