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To Assess the Effect of HDF Versus High Flux Dialysis on Free Light Chains and Cumulative Albumin Loss, in End Stage Renal Disease Patients.

Primary Purpose

End Stage Renal Disease, Hemodiafiltration, Hemodialysis

Status
Completed
Phase
Not Applicable
Locations
Egypt
Study Type
Interventional
Intervention
BIOPURE 260HF dialyzer
Sponsored by
Ain Shams University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for End Stage Renal Disease focused on measuring End stage renal disease (ESRD), hemodiafiltration (HDF), hemodialysis (HD), Free light chains, Albumin loss, Kappa and lambda

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Prevalent HD patients on regular hemodialysis sessions for >6 months 3 sessions/week of 4 hours duration.
  • Patients with Arterio-venous fistula as dialysis access.

Exclusion Criteria:

  • Patients with hemodialysis catheters.
  • Patients with active inflammation or infection.
  • Decompensated heart failure.
  • Liver Cell Failure ( Child B,C)
  • Patients with known malignancies.

Sites / Locations

  • Ain Shams University Hospitals

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

High-flux Hemodialysis

Hemodiafiltration

Arm Description

patients treated by conventional hemodialysis

patients treated by online post-dilution hemodialysis

Outcomes

Primary Outcome Measures

Free light chain reduction
Measurement of kappa (23KDa) and lambda (45 KDa)free light chains levels, pre and post dialysis session, in patients undergoing high-flux dialysis versus HDF.

Secondary Outcome Measures

Cumulative albumin loss
Assessment of cumulative dialysate albumin loss by measuring albumin spent in dialysate -hourly- in patients undergoing high flux dialysis versus HDF

Full Information

First Posted
February 6, 2021
Last Updated
March 11, 2022
Sponsor
Ain Shams University
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1. Study Identification

Unique Protocol Identification Number
NCT04747067
Brief Title
To Assess the Effect of HDF Versus High Flux Dialysis on Free Light Chains and Cumulative Albumin Loss, in End Stage Renal Disease Patients.
Official Title
The Effect of Hemodiafiltration Versus High Flux Dialysis On Free Light Chains Reduction And Its Relation To Albumin Loss.
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
February 1, 2021 (Actual)
Primary Completion Date
May 1, 2021 (Actual)
Study Completion Date
September 1, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ain Shams University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Removal of uremic toxins is the main goal of HD, It was improved by using high volume convective technique with high flux (HF) dialyzer. This technique removes medium - large molecular weight solutes giving higher dialysis adequacy and consequently improving the quality of life. This study will assess the effect of hemodiafiltration (HDF) versus high flux dialysis on free light chains (FLC) reduction as a marker of HD adequacy and its relation to albumin loss using dialyzer effective surface area 2.6m2.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
End Stage Renal Disease, Hemodiafiltration, Hemodialysis
Keywords
End stage renal disease (ESRD), hemodiafiltration (HDF), hemodialysis (HD), Free light chains, Albumin loss, Kappa and lambda

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
It is a pilot crossover study, 25 ESRD patients were dialyzed using dialyzer; BIOPURE 260 HF on a single session on two hemodialysis modalities (conventional HD and online post-dilution HDF) with washout period of 2 weeks using high flux dialyzers with maximum surface area 2.0 m2.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
High-flux Hemodialysis
Arm Type
Experimental
Arm Description
patients treated by conventional hemodialysis
Arm Title
Hemodiafiltration
Arm Type
Experimental
Arm Description
patients treated by online post-dilution hemodialysis
Intervention Type
Device
Intervention Name(s)
BIOPURE 260HF dialyzer
Intervention Description
Dialyzer with effective surface area 2.6 m2, High-flux polyethersulfone hollow fiber with steam sterilization, myoglobin sieving coefficient (SC) 0.7, membrane cutoff 40,000 Daltons (Allmed Medical Gmbh)
Primary Outcome Measure Information:
Title
Free light chain reduction
Description
Measurement of kappa (23KDa) and lambda (45 KDa)free light chains levels, pre and post dialysis session, in patients undergoing high-flux dialysis versus HDF.
Time Frame
1 day of hemodialysis session
Secondary Outcome Measure Information:
Title
Cumulative albumin loss
Description
Assessment of cumulative dialysate albumin loss by measuring albumin spent in dialysate -hourly- in patients undergoing high flux dialysis versus HDF
Time Frame
1 day of hemodialysis session

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Prevalent HD patients on regular hemodialysis sessions for >6 months 3 sessions/week of 4 hours duration. Patients with Arterio-venous fistula as dialysis access. Exclusion Criteria: Patients with hemodialysis catheters. Patients with active inflammation or infection. Decompensated heart failure. Liver Cell Failure ( Child B,C) Patients with known malignancies.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Reem Sultan, M.Sc
Organizational Affiliation
Faculty of Medicine, Ain Shams Univeristy.
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Hesham ElSayed, PhD
Organizational Affiliation
Faculty of Medicine, Ain Shams Univeristy
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Magdy ElSharkawy, PhD
Organizational Affiliation
Faculty of Medicine, Ain Shams Univeristy
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Waleed AbdelMohsen, PhD
Organizational Affiliation
Faculty of Medicine, Ain Shams Univeristy
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Shaimaa Zaki, PhD
Organizational Affiliation
Faculty of Medicine, Ain Shams Univeristy
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Ahmed Emara, PhD
Organizational Affiliation
Faculty of Medicine, Ain Shams Univeristy
Official's Role
Study Director
Facility Information:
Facility Name
Ain Shams University Hospitals
City
Cairo
State/Province
Governorate
ZIP/Postal Code
0000
Country
Egypt

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
26022721
Citation
Bourguignon C, Chenine L, Bargnoux AS, Leray-Moragues H, Canaud B, Cristol JP, Morena M. Hemodiafiltration improves free light chain removal and normalizes kappa/lambda ratio in hemodialysis patients. J Nephrol. 2016 Apr;29(2):251-257. doi: 10.1007/s40620-015-0207-z. Epub 2015 May 29.
Results Reference
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PubMed Identifier
27884120
Citation
Donati G, Moretti MI, Baraldi O, Spazzoli A, Capelli I, Comai G, Marchetti A, Sarma M, Mancini R, La Manna G. Removal of free light chains in hemodialysis patients without multiple myeloma: a crossover comparison of three different dialyzers. BMC Nephrol. 2016 Nov 25;17(1):193. doi: 10.1186/s12882-016-0405-5.
Results Reference
background
PubMed Identifier
24603634
Citation
Lamy T, Henri P, Lobbedez T, Comby E, Ryckelynck JP, Ficheux M. Comparison between on-line high-efficiency hemodiafiltration and conventional high-flux hemodialysis for polyclonal free light chain removal. Blood Purif. 2014;37(2):93-8. doi: 10.1159/000357968. Epub 2014 Mar 1.
Results Reference
background
PubMed Identifier
29813181
Citation
Maduell F. Hemodiafiltration versus conventional hemodialysis: Should "conventional" be redefined? Semin Dial. 2018 Nov;31(6):625-632. doi: 10.1111/sdi.12715. Epub 2018 May 29.
Results Reference
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PubMed Identifier
28452109
Citation
Nagai K, Tsuchida K, Ishihara N, Minagawa N, Ichien G, Yamada S, Hirose D, Michiwaki H, Kanayama HO, Doi T, Minakuchi J. Implications of Albumin Leakage for Survival in Maintenance Hemodialysis Patients: A 7-year Observational Study. Ther Apher Dial. 2017 Aug;21(4):378-386. doi: 10.1111/1744-9987.12526. Epub 2017 Apr 27.
Results Reference
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PubMed Identifier
29106652
Citation
van Gelder MK, Abrahams AC, Joles JA, Kaysen GA, Gerritsen KGF. Albumin handling in different hemodialysis modalities. Nephrol Dial Transplant. 2018 Jun 1;33(6):906-913. doi: 10.1093/ndt/gfx191.
Results Reference
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PubMed Identifier
29507008
Citation
Wolley M, Jardine M, Hutchison CA. Exploring the Clinical Relevance of Providing Increased Removal of Large Middle Molecules. Clin J Am Soc Nephrol. 2018 May 7;13(5):805-814. doi: 10.2215/CJN.10110917. Epub 2018 Mar 5.
Results Reference
background
PubMed Identifier
30281131
Citation
Wolley MJ, Hutchison CA. Large uremic toxins: an unsolved problem in end-stage kidney disease. Nephrol Dial Transplant. 2018 Oct 1;33(suppl_3):iii6-iii11. doi: 10.1093/ndt/gfy179.
Results Reference
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To Assess the Effect of HDF Versus High Flux Dialysis on Free Light Chains and Cumulative Albumin Loss, in End Stage Renal Disease Patients.

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