ReviewNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2018
Current approaches to middle molecule removal: room for innovation.
Review in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 39 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
39 citing papers in PubMed, 88 citations in OpenAlex.
- A safe and effective protocol for postdilution hemofiltration with regional citrate anticoagulation.BMC nephrology · 2024Trial
- Safety of a Novel Dialyzer Containing a Fluorinated Polyurethane Surface-Modifying Macromolecule in Patients with End-Stage Kidney Disease.Blood purification · 2021Trial
- Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial.Critical care (London, England) · 2020Trial
- Effect of hemoperfusion plus hemodialysis on uremic toxins and anemia in patients with maintenance hemodialysis.Renal failure · 2026Article
- Review
- Tryptophan metabolites clearance in hemodialyzed patients.Amino acids · 2026Article
- Longitudinal impact of extended-hours hemodialysis with a liberalized diet on nutritional status and survival outcomes: findings from the LIBERTY cohort.Clinical and experimental nephrology · 2025Article
- Article
- Medium cut-off dialyzer improves reduction ratios of large middle molecules associated with vascular calcification.Kidney research and clinical practice · 2024Article
- The ADVanced Organ Support (ADVOS) hemodialysis system removes IL-6: an in vitro proof-of-concept study.Intensive care medicine experimental · 2024Article
- Current dialyzer classification in Japan and mortality risk in patients undergoing hemodialysis.Scientific reports · 2024Article
- Hemoadsorption in Organ Preservation and Transplantation: A Narrative Review.Life (Basel, Switzerland) · 2023Review
- Removal performance of pre- and post-dilution online hemodiafiltration using identical hemodiafilters in the same patients.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2023Article
- Comparison of the medium cutoff dialyzer and postdilution hemodiafiltration on the removal of small and middle molecule uremic toxins.Kidney research and clinical practice · 2023Article
- Review
- Design of Beta-2 Microglobulin Adsorbent Protein Nanoparticles.Biomolecules · 2023Article
- Efficacy and Safety of the Medium Cut-Off Elisio HX Dialyzer.Blood purification · 2023Article
- Impact of needle type on substitution volume during online hemodiafiltration: plastic cannulae versus metal needles.Kidney research and clinical practice · 2023Article
- The effect of cytosorb® application on kidney recovery in critically ill patients with severe rhabdomyolysis: a propensity score matching analysis.Renal failure · 2023Article
- Comparison of four medium cut-off dialyzers.Clinical kidney journal · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Aggressive removal of middle molecules or larger low-molecular-weight proteins (LMWPs) has been a growing concern following studies on their harmful effects on the mortality and morbidity of chronic dialysis patients. To remove larger LMWPs and some protein-bound uremic toxins (PBUTs), high- and medium-cutoff (HCOs and MCOs, respectively) membranes, convective therapy and protein adsorptive membranes are available. When we use HCO or MCO membranes for convective therapy, we have to take care to avoid massive albumin leakage during a dialysis session. Convection volume is an important element to increase middle molecule removal; however, a larger convection volume has a risk of larger leakage of albumin. Predilution hemodiafiltration is a useful measurement to increase larger LMWPs without massive albumin leakage. β2-microglobulin (B2M), α1-microglobulin (A1M) and albumin leakage during a dialysis session are useful parameters for assessing middle-molecule removal. Reduction ratios of B2M >80% and of A1M >35% are favorable to improve severe dialysis-related symptoms. The efficacy of middle molecule removal should be evaluated in comparison with clinical outcomes, mortality, morbidity and the improvement of dialysis-related symptoms. Recently some dialysis-related symptoms such as sleep disturbance, skin itchiness and dialysis hypotension have been recognized as good surrogate makers for mortality. Further studies to evaluate the relationship between middle molecule or PBUTs removal and the improvement of patient symptoms should be performed in well-designed randomized controlled trials.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.