title: [Selective adsorption of homocysteine using HFR-on line technique].
abstract: Homocysteine (Hcy) is grossly elevated in hemodialysis (HD) patients. Treatment with folic acid and/or vitamin B12 fails to normalize Hcy levels in the majority of patients. Treatment with various dialyzers with different flux characteristics has produced contrasting results. Hemodiafiltration reinfusion (HFR) on-line (double chamber hemodiafiltration (HDF) with regenerated ultrafiltrate reinfusion) is a novel method combining the processes of diffusion, convection and absorbance. The ultrafiltrate is regenerated through a charcoal-resin device. Our aim was to observe the effect of the HFR on-line technique on removing Hcy. We investigated the effect of this treatment on Hcy levels in 10 patients with a mean Hcy level of 57.6 micromol/L (range 24.1-119.7). We measured Hcy, folate and vitamin B12 pre- and post-dialysis and in the ultrafiltrate pre- and post-cartridge at 10, 120 and 240 min. Mean Hcy levels were 57.6 and 35.3 micromol/L (range 9.9-80.3) (p=0.005) pre- and post-dialysis, respectively, while folate and vitamin B12 were unchanged. Pre- and post-cartridge Hcy levels were 11.6 vs 2.5 (p=0.005), 9.3 vs 3.9 (p=0.005), 7.7 vs 4.6 micromol/L (p=0.012) at three time points considered, while folate and vitamin B12 were essentially undetectable. These preliminary data, which need confirmation in a long-term study, seem to indicate that HFR on-line reduces Hcy levels, not only through a possible reduction in uremic toxins, but also through the actual removal of Hcy by absorbance on the charcoal-resin cartridge.
authors.affiliation: Servizio di Nefrologia e Dialisi, Policlinico Tor Vergata, Rome. splendiani@med.uniroma2.it
authors.forename: A
authors.initials: A
authors.lastname: De Angelis
authors.forename: T
authors.initials: T
authors.lastname: Tullio
authors.forename: M
authors.initials: M
authors.lastname: Ferrannini
authors.forename: A
authors.initials: A
authors.lastname: Vega
authors.forename: M R
authors.initials: MR
authors.lastname: Dessì
authors.forename: S
authors.initials: S
authors.lastname: Casciani
authors.forename: R
authors.initials: R
authors.lastname: Ruggia
authors.forename: A
authors.initials: A
authors.lastname: Pastore
authors.forename: C
authors.initials: C
authors.lastname: Cortese
authors.forename: G
authors.initials: G
authors.lastname: Splendiani
mesh_terms: D000328:Adult; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D006710:Homocysteine