Medium Cut-Off Dialysis Membrane and Dietary Fiber Effects on Inflammation and Protein-Bound Uremic Toxins: A Systematic Review and Protocol for an Interventional Study
Abstract
:1. Introduction
2. Results
2.1. Performance of Medium Cut-Off Dialyzers in the Elimination of Middle Molecules and Protein-Bound Uremic Toxins Compared to Hemodiafiltration or High-Flux Hemodialysis
2.2. Impact of Increased Dietary Fiber Supplementation on Serum Concentration of PCS, IS and Inflammatory Markers
2.3. Quality Assessment
3. Discussion and an Interventional Trial Proposal
- Experimental group: 4 weeks of dialysis with medium cut-off (Theranova) membrane (first phase), and dialysis for 8 weeks with the same membrane and increased fiber and sodium propionate intake (second phase);
- Control group: 4 weeks of dialysis with a high-flux membrane using online hemodiafiltration (first phase) and 8 weeks of high-flux membrane hemodiafiltration and increased fiber and sodium propionate intake (second phase).
Sample Size
4. Conclusions
5. Materials and Methods
5.1. Literature Search Strategy
5.2. Inclusion and Exclusion Criteria
5.3. Quality Assessment
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study | Sample Size | Exp Intervention | Con Intervention | Duration | Endpoint | Results |
---|---|---|---|---|---|---|
Weiner, 2020 [36] | Exp (n = 86) Con (n = 86) | MCO membrane | High-flux HD | 24 weeks | IL-6 | Exp: 15% ↓ |
Con: 50.6% ↑ | ||||||
p Exp vs. Con n.s. | ||||||
TNF-α | Exp: 48.9% ↓ | |||||
Con: 34.7% ↓ | ||||||
p Exp vs. Con n.s. | ||||||
Zickler, 2017 † [37] | Exp (n = 23) Con (n = 25) | MCO membrane | High-flux HD | 4 weeks of each dialysis modality + 8 weeks of extension phase | IL-6 | Exp: 33.3% ↓ ** |
Con: 43.9% ↓ * | ||||||
p Exp vs. Con n.s. | ||||||
TNF-α | Exp: 14.5% ↓ ** | |||||
Con: 5.1% ↓ | ||||||
p Exp vs. Con n.s. | ||||||
CRP | Exp: 39.2% ↓ | |||||
Con: 28.4% ↓ | ||||||
p Exp vs. Con n.s. | ||||||
Belmouaz, 2020 [38] | Exp (n = 20) Con (n = 20) | MCO membrane | High-flux HD | 3 months of each dialysis modality | IL-6 | Exp: 6.3% ↑ |
Con: 12.8% ↑ | ||||||
p Exp vs. Con n.s. | ||||||
TNF-α | Exp: 19.4% ↓ | |||||
Con: 16.4% ↓ | ||||||
p Exp vs. Con n.s. | ||||||
CRP | Exp: missing data 1 | |||||
Con: missing data 1 | ||||||
p Exp vs. Con n.s. |
Study | Sample Size | Exp Intervention | Con Intervention | Duration | Endpoint | Results |
---|---|---|---|---|---|---|
Khosroshahi, 2019 [18] | Exp (n = 23) Con (n = 21) | 20–25 g of HAM-RS2 20 g week 1–4 25 g week 5–8 | 20–25 g of waxy corn starch 20 g week 1–4 25 g week 5–8 | 8 weeks | Exp: 31.5% ↓ * | |
PC | Con: 0.7% ↑ | |||||
p Exp vs. Con 0.992 | ||||||
Exp: 2.96% ↑ | ||||||
IS | Con: 11.7% ↑ | |||||
p Exp vs. Con 0.606 | ||||||
Exp: 110.6% ↑ | ||||||
Con: 25.05% ↑ | ||||||
hs-CRP | p Exp vs. Con 0.866 | |||||
Esgalhado, 2018 [19] | Exp (n = 15) Con (n = 16) | 16 g HAM-RS2 | 20 g manioc flour | 4 weeks | Exp: 18.15% ↓ ** | |
IS | Con: 9.28% ↑ | |||||
p Exp vs. Con 0.008 | ||||||
Exp: 6.83% ↑ | ||||||
Con: 1.53% ↓ | ||||||
PCS | p Exp vs. Con 0.77 | |||||
Exp: 11.86% ↓ ** | ||||||
Con: 3.28% ↓ | ||||||
IL-6 | p Exp vs. Con 0.06 | |||||
Exp: 20.0 ↓ | ||||||
Con: 12.77 ↓ | ||||||
hs-CRP | p Exp vs. Con 0.16 | |||||
Sirich, 2014 [20] | Exp (n = 20) Con (n = 20) | 15 g HAM-RS2 week 1, 30 g HAM-RS2 week 2–6 | 15 g waxy corn starch week 1, 30 g waxy corn starch week 2–6 | 6 weeks | Exp: 30.56% ↓ * | |
free IS | Con: 0% | |||||
p Exp vs. Con 0.02 | ||||||
Exp: 17.14% ↓ | ||||||
Con: 3.12% ↓ | ||||||
total IS | p Exp vs. Con 0.04 | |||||
Exp: 22.22% ↓ | ||||||
Con: 4.55% ↑ | ||||||
free PCS | p Exp vs. Con 0.05 | |||||
Exp: 12.12 % ↓ | ||||||
Con: 3.12% ↓ | ||||||
total PCS | p Exp vs. Con 0.63 | |||||
Exp: 10% ↑ | ||||||
Con: 33.33 % ↑ | ||||||
CRP | p Exp vs. Con 0.11 | |||||
Xie, 2015 [22] | ExpA (n = 41) ExpB (n = 39) Con (n = 44) | ExpA: 10 g water soluble fiber ExpB: 20 g water soluble fiber | placebo starch | 6 weeks | ExpA: 32.63% ↓ * | |
ExpB: 27.22% ↓ * | ||||||
IL-6 | Con: 6.19% ↑ | |||||
p ExpA vs. Con < 0.05 | ||||||
p ExpB vs. Con < 0.05 | ||||||
ExpA: 76.58% ↓ * | ||||||
ExpB: 62.25% ↓ * | ||||||
Con: 10.05% ↑ | ||||||
IL-8 | p ExpA vs. Con < 0.05 | |||||
p ExpB vs. Con < 0.05 | ||||||
ExpA: 24.06% ↓ * | ||||||
ExpB: 15.2% ↓ * | ||||||
Con: 0.77% ↑ | ||||||
TNF-α | p ExpA vs. Con < 0.05 | |||||
p ExpB vs. Con < 0.05 | ||||||
ExpA: 55.14% ↓ * | ||||||
ExpB: 52.04% ↓ * | ||||||
Con: 1.06% ↑ | ||||||
p ExpA vs. Con < 0.05 | ||||||
hs-CRP | p ExpB vs. Con < 0.05 | |||||
Khosroshahi, 2018 [21] | Exp (n = 22) Con (n = 22) | 20–25 g of HAM-RS2 20 g week 1–4 25 g week 5–8 | 20–25 g regular wheat-flour 20 g week 1–4 25 g week 5–8 | 8 weeks | Exp: 25.0% ↓ * | |
IL-6 | Con: 21.9% ↑ | |||||
p Exp vs. Con < 0.01 | ||||||
Exp: 6.49% ↓ | ||||||
Con: 20.0% ↑ | ||||||
IL-1β | p Exp vs. Con. n.s. | |||||
Exp: 18.23% ↓ * | ||||||
Con: 43.14% ↑ *** | ||||||
p Exp vs. Con 0.01 | ||||||
TNF-α | ||||||
Exp: 21.6% ↑ | ||||||
Con: 1.27% ↑ | ||||||
hs-CRP | p Exp vs. Con n.s. |
Study | Criterion 1 | Criterion 2 | Criterion 3 | Criterion 4 | Criterion 5 | Criterion 6 | Criterion 7 | Criterion 8 | Criterion 9 | Criterion 10 | Criterion 11 | Score |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Weiner 2020 | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 6 |
Zickler 2017 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 8 |
Belmouaz 2020 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 5 |
Khosroshahi 2019 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 9 |
Esgalhado 2018 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 7 |
Sirich 2014 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 5 |
Xie 2015 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 7 |
Khosroshahi 2018 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 8 |
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Herič, T.; Vivoda, T.; Bogataj, Š.; Pajek, J. Medium Cut-Off Dialysis Membrane and Dietary Fiber Effects on Inflammation and Protein-Bound Uremic Toxins: A Systematic Review and Protocol for an Interventional Study. Toxins 2021, 13, 244. https://doi.org/10.3390/toxins13040244
Herič T, Vivoda T, Bogataj Š, Pajek J. Medium Cut-Off Dialysis Membrane and Dietary Fiber Effects on Inflammation and Protein-Bound Uremic Toxins: A Systematic Review and Protocol for an Interventional Study. Toxins. 2021; 13(4):244. https://doi.org/10.3390/toxins13040244
Chicago/Turabian StyleHerič, Tjaša, Tjaša Vivoda, Špela Bogataj, and Jernej Pajek. 2021. "Medium Cut-Off Dialysis Membrane and Dietary Fiber Effects on Inflammation and Protein-Bound Uremic Toxins: A Systematic Review and Protocol for an Interventional Study" Toxins 13, no. 4: 244. https://doi.org/10.3390/toxins13040244