Biocompatibility of heparin-grafted hemodialysis membranes: impact on monocyte chemoattractant protein-1 circulating level and oxidative status.
This prospective observational study aimed at evaluating efficacy and biocompatibility performances of the new heparin-coated Evodial dialyzers with/without systemic heparin reduction. After a 4-week wash-out period with reference polysulfone F70S dialyzers, 6 hemodialysis patients were sequentially dialyzed with Evodial, F70S, and Evodial dialyzers using 30% heparin reduction, each period of treatment was 4 weeks. Removal rates (RR) (urea, creatinine, and β2-microglobulin), dialysis dose, and instantaneous clearances (urea and creatinine) were measured as well as inflammatory (C-reactive protein, fibrinogen, interleukin 6, tumor necrosis factor α, and monocyte chemoattractant protein-1) and oxidative stress (OS) (superoxide anion, homocysteine, and isoprostanes) parameters at the end of each study period. Patients treated with Evodial or F70S dialyzers for 4 weeks presented comparable dialysis efficacy parameters including urea and creatinine RR, dialysis dose and instantaneous clearances. By contrast, a significantly lower but reasonably good β2-microglobulin RR was achieved with Evodial dialyzers. Regarding biocompatibility, no significant difference was observed with inflammation and OS except for postdialysis monocyte chemoattractant protein-1 which significantly decreased with Evodial dialyzers. Thirty percent heparinization reduction with Evodial dialyzers did not induce any change in inflammation but led to an improvement in OS as demonstrated by a decrease in postdialysis superoxide production and predialysis homocysteine and isoprostane. This bioactive dialyzer together with heparin dose reduction represents a good trade-off between efficacy and biocompatibility performance (improvement in OS with a weak decrease in efficacy) and its use is encouraging for hemodialysis patients not only in reducing OS but also in improving patient comorbid conditions due to lesser heparin side effects.
Biochemistry Laboratory, CHRU Montpellier, F-34000 France.
Marion
M
Morena
Isabelle
I
Jaussent
Lotfi
L
Chalabi
Anne-Sophie
AS
Bargnoux
Anne-Marie
AM
Dupuy
Stéphanie
S
Badiou
Claire
C
Rakic
Michel
M
Thomas
Bernard
B
Canaud
Jean-Paul
JP
Cristol
Françoise
F
Michel
D000368:Aged; D001672:Biocompatible Materials; D018932:Chemokine CCL2 / Q000097:blood*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D007688:Kidneys, Artificial; D008297:Male; D008422:Materials Testing; D008567:Membranes, Artificial; D008875:Middle Aged; D018384:Oxidative Stress; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods
D001672:Biocompatible Materials; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D018836:Inflammation Mediators; D008567:Membranes, Artificial; D006493:Heparin