No benefit of hemodiafiltration over hemodialysis in lowering elevated levels of asymmetric dimethylarginine in ESRD patients.
BACKGROUND
It has been suggested that hemodiafiltration (HDF) is more efficient than hemodialysis (HD) in lowering plasma levels of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA), which is a strong and independent predictor of overall mortality in ESRD patients.


METHODS
Twenty ESRD patients (11 women) were studied during both a single online HDF session and a single HD session. In each patient, ADMA, L-arginine, SDMA, beta(2)-microglobulin and urea were measured at several time points.


RESULTS
Although HDF was clearly superior to HD in decreasing plasma beta(2)-microglobulin, there was no difference in the elimination characteristics of ADMA. However, HDF but not HD eliminated the nitric oxide synthase substrate L-arginine, making HD superior in increasing the L-arginine/ADMA ratio.


CONCLUSIONS
Neither HD nor HDF sufficiently removes the putative uremic toxin ADMA. The clinical significance of HD better improving the L-arginine/ADMA ratio (parameter of NO production) as compared to HDF needs to be determined.
Kalousová
Marta
M
Institute of Clinical Chemistry and Laboratory Diagnostics,Charles University and General University Hospital, Prague, Czech Republic.
Kielstein
Jan T
JT
Hodková
Magdaléna
M
Zima
Tomás
T
Dusilová-Sulková
Sylvie
S
Martens-Lobenhoffer
Jens
J
Bode-Boger
Stefanie M
SM
D000328:Adult; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood / Q000652:urine; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000628:therapy / Q000652:urine; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors; D001613:beta 2-Microglobulin / Q000097:blood
D001613:beta 2-Microglobulin; D009569:Nitric Oxide; C018524:N,N-dimethylarginine; D001120:Arginine; D019001:Nitric Oxide Synthase