Effects of low- and high-flux dialyzers on oxidative stress and insulin resistance.
BACKGROUND
Cardiovascular disease (CVD) is the leading cause of mortality in patients with end-stage renal disease (ESRD). The cornerstone of high CVD incidence in ESRD patients is endothelial dysfunction which results from inflammation, oxidative stress and insulin resistance. Although various modalities of hemodialysis (HD) have been presumed to exert different effects on oxidative stress and insulin resistance, solid evidence is still lacking.


METHODS
40 ESRD patients undergoing HD were prospectively enrolled and divided randomly into two groups. Patients in each group received either F8 HPS (low-flux) (Group A) or FX80 (high-flux) (Group B) as HD dialyzers for 2 consecutive months. Diet pattern and medications were kept as usual in both groups to avoid considerable blood glucose change during study period. Blood samples were taken at the start and end of the study.


RESULTS
A total of 38 patients (18 and 20 for Groups A and B, respectively) completed the study. Within each group, there was no change in adiponectin, plasma 8-iso-prostaglandin F(2)(alpha), high-sensitivity C-reactive protein, blood glucose and insulin after 2 months of treatment except a significant change of HOMA(IR) (p = 0.02) in high-flux group. The significant change of HOMA(IR) between the two groups (p = 0.017) mainly results from the parallel change of insulin between the two groups (p = 0.03).


CONCLUSIONS
For patients receiving HD, the high-flux dialyzer with synthetic polysulfone membranes fails to provide a better anti-inflammatory or antioxidative effect than the low-flux dialyzer; however, the high-flux dialyzer does significantly improve insulin resistance in this short-term study. This result implies that the high-flux dialyzer might provide better cardiovascular protection than the low-flux dialyzer. Therefore, the low-flux dialyzer might be considered for patients who only need short-term HD therapy. Regarding patients under long-term maintenance HD therapy, a high-flux dialyzer might be the choice of dialyzer.
Chu
Pei-Lun
PL
Duke University, Cell and Molecular Biology Program, Durham, NC, USA.
Chiu
Yen-Ling
YL
Lin
Jou-Wei
JW
Chen
Shih-I
SI
Wu
Kwan-Dun
KD
D052242:Adiponectin; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D015237:Dinoprost / Q000031:analogs & derivatives; D042783:Endothelial Cells; D004730:Endothelium, Vascular; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D018384:Oxidative Stress; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation
D052242:Adiponectin; D008567:Membranes, Artificial; C075750:8-epi-prostaglandin F2alpha; D015237:Dinoprost