Authors (including presenting author) :
Ng YL(1), Chan WH(1), Hui CF(1), Chan PL(1), Leung SF(1), Mok SK(1), Chan KHA(1), Chung SK(1), Hui YH(1), Tam CH(1), Wong SHS(1)
Affiliation :
(1)Renal Unit, Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
End-stage renal disease causes accumulation of uremic toxins that are normally excreted or metabolized by the kidney. It was reported that haemodialysis (HD) with the new medium cut-off (MCO) dialyzer was more effective in removing large middle molecules up to approximately 50kDa. Recently, our center started providing HD with MCO dialyzer (MCO therapy) for four patients with significant neuropathic symptoms who were receiving hemodiafiltration previously.
Objectives :
To explore the effect of MCO therapy with respect to hand pain and numbness relieving in chronic HD patients.
Methodology :
From April to June 2018, four patients were asked to recall the average number of awakened night due to hand pain and numbness. They reported their pain severity with Numeric Rating Scale (NRS) and numbness severity with numbness scale adapted from symptom severity scale for Carpel Tunnel Syndrome before and during MCO therapy. Their biological parameters were also compared. Bilateral hand functions of patients were assessed by occupational therapist before and after MCO therapy.
Result & Outcome :
All patients claimed that their symptoms decreased and had better sleeping quality. There was 88% reduction in the number of awakening nights. Patients scored their pain level more than 5 in 280 nights before MCO therapy and reduced to 20 nights after started MCO therapy. Their numbness level also showed improvement after 4 to 6 weeks of MCO therapy. Their hand functions including hand grip and pinch strength were significantly improved in the objective assessment by occupational therapist. This therapy was well tolerated by all these four patients and there were no differences in their haemodynamic stability. The beta-2 microglobulin (B2M) level was similar before and after MCO therapy. No significant change was identified in serum albumin level. In conclusion, this retrospective review illustrated that the MCO therapy is effective and safe in hand pain and numbness relief of chronic HD patients. Our patients reported to have better sleeping quality and hand functions and hence their quality of life was improved. Further prospective randomized control trial is recommended to evaluate the efficacy of MCO therapy in symptoms relief for chronic HD patients.
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