Microinflammation induces endothelial damage in hemodialysis patients: the role of convective transport.
Cardiovascular complications are a major cause of mortality in hemodialysis patients. On-line hemofiltration combines convective clearance for removing large solutes with diffusion to remove small solutes and is associated with a significant reduction of inflammation and improved patient survival. We compared on-line hemofiltration to high-flux hemodialysis (HF-HD) in patients in a sequential manner. At baseline, 15 stable patients on HF-HD as compared with five control subjects showed significant increases in CD14+CD16+ cells, endothelial microparticles, and endothelial progenitor cells (EPCs). After 4 months of on-line hemofiltration, the number of CD14+CD16+ cells, microparticles, and EPCs decreased. After returning to HF-HD for 4 months, all measured parameters returned to their respective baseline values. The number of CD14+CD16+ cells correlated with both endothelial microparticles and EPCs. We conclude that on-line hemofiltration attenuates endothelial dysfunction possibly by decreasing microinflammation. This effect may be directly caused by a modulatory effect of on-line hemofiltration on proinflammatory cells or by a complex interaction that encompasses a wider removal of uremic toxins.
Ramirez
R
R
Unidad de Investigación, Servicio de Nefrología, Hospital Universitario Reina Sofía Avda Menendez Pidal S/N, Córdoba 14004, Spain. manuelr.ramirez.sspa@juntadeandalucia.es
Carracedo
J
J
Merino
A
A
Nogueras
S
S
Alvarez-Lara
M A
MA
Rodríguez
M
M
Martin-Malo
A
A
Tetta
C
C
Aljama
P
P
D000328:Adult; D000368:Aged; D017304:Annexin A5 / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002478:Cells, Cultured; D002908:Chronic Disease; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000473:pathology / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008297:Male; D008875:Middle Aged; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D017452:Receptors, IgG / Q000097:blood; D006435:Renal Dialysis / Q000379:methods*; D013234:Stem Cells / Q000378:metabolism / Q000473:pathology
D017304:Annexin A5; D018950:Lipopolysaccharide Receptors; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D017452:Receptors, IgG