Hemodialysis - Middle Molecule Removal

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2005

Careful consideration of high-flux membranes for patients >5 years dialysis (Level III)

Dialysis adequacy HD
Dialysis membranes

CSN-Canada

EBPG-Europe
2002

• β2-M representative for large molecules
• β2-M removal to be pursued by high-flux membranes
• Additional convective strategies, longer dialysis time or higher dialysis frequency to maximize middle molecule removal
(guideline II.2.2.) (Level B)

Guideline II.2. Hemodialysis dose quantification :  middle molecules

KDOQI-US
2002

• Screening for β2-microglobulin amyloidosis in not recommended (Opinion)
• No currently available therapy (except kidney transplantation) can stop disease progression or provide symptomatic relief (Evidence)
• Kidney transplant should be considered to stop disease progression or provide symptomatic relief in patients with β2-microglobulin amyloidosis (Evidence)
• In a patient with evidence of, or at risk for β2-microglobulin amyloidosis, noncuprophane
high-flux dialyzers should be used  (Opinion)

Guideline 10. β2-microglobulin amyloidosis

UK-Guidelines
2007

The balance of evidence supports the use of a dialysis regimen with enhanced removal of middle molecules in incident patients who are predicted to remain on HD for several years and prevalent patients who have been on HDfor more than 3.7 years. Such patients are at risk of developing symptoms of dialysis-related amyloidosis. Treatments with better clearance of middle molecules include HD with high flux synthetic membranes and haemodiafiltration. The proven benefits of high flux synthetic membranes in randomized trials are limited to advantages arising from improved biocompatibility and enhanced removal of middle molecules, such as beta-2-microglobulin, rather than better patient survival rates. Chronic high flux dialysis in the HEMO study did not affect the primary outcome of all cause mortality or any of the secondary composite outcome measures including the rates of first cardiac hospitalization or all cause mortality, first infectious hospitalization or all cause mortality, first 15% decrease in serum albumin or all cause mortality, or all non-vascular access-related hospitalizations

Haemodialysis Guideline –
Haemodialysis Membranes