title: Switch from bicarbonate hemodialysis to hemodiafiltration with online regeneration of the ultrafiltrate (HFR): effects on nutritional status, microinflammation, and beta-microglobulin.
abstract: BACKGROUND
  Hemodiafiltration (HFR) with on-line regeneration of the ultrafiltrate, a technique of hemodiafiltration in which the ultrafiltrate passes through a cartridge containing uncoated charcoal, has been shown to be safe, simple, and well tolerated and has been claimed to improve nutritional status or to prevent its deterioration while decreasing the inflammatory response via a reduced production of proinflammatory cytokines. The purpose of the present prospective study was to ascertain whether HRF improves the nutritional status, reduces microinflammation, and decreases serum beta2-microglobulin levels in patients with end-stage renal disease (ESRD).
  
  
  METHODS
  Eight patients, four males and four females, with a mean age of 49.4 +/- 16.8 years, stable on hemodialysis over a period of 8.7 +/- 6.1 years and on standard 4-4.5 h three-times-a-week bicarbonate hemodialysis, were switched to three-times-a-week, 4-h HFR. At baseline and every two months for 12 months at mid-week, serum levels of urea, creatinine, albumin, total cholesterol, C-reactive protein, fibrinogen, complement, ferritin, beta2-microglobulin, intact parathyroid hormone (PTH), hemoglobin concentrations, and hematocrit and the EPO weekly dose were determined. At baseline and at the end of the study, the Malnutrition Inflammatory Score (MIS) was calculated.
  
  
  RESULTS
  Nutritional and inflammatory parameters remained constant during the 12-month period of the study. After 12 months of HFR, the MIS trended to be lower, but the difference was not statistically significant. Serum beta2-microglobulin and PTH levels remained constant during all time intervals. Neither hematocrit nor hemoglobin changed over the course of the study as well as the weekly EPO dose.
  
  
  CONCLUSIONS
  The change from bicarbonate hemodialysis to HFR was safe and well tolerated but was not associated with an improvement of nutritional and inflammatory parameters or a reduction of serum beta2-microglobulin levels.
authors.affiliation: Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy. maubosso@tin.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
authors.forename: Luigi
authors.initials: L
authors.lastname: Tazza
authors.forename: Stefania
authors.initials: S
authors.lastname: Giungi
authors.forename: Nicola
authors.initials: N
authors.lastname: Panocchia
authors.forename: Filippo
authors.initials: F
authors.lastname: Rossi Fanelli
authors.forename: Giovanna
authors.initials: G
authors.lastname: Luciani
mesh_terms: D000704:Analysis of Variance; D001639:Bicarbonates; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D006435:Renal Dialysis; D001613:beta 2-Microglobulin / Q000378:metabolism
chemical_list: D001639:Bicarbonates; D001613:beta 2-Microglobulin