title: Does hemodiafiltration improve the removal of homocysteine?
abstract: High prevalence of hyperhomocysteinemia is common in hemodialysis (HD) patients and could contribute to worsen the cardiovascular risk. Beyond vitamin B status, dialysis modality itself could influence homocysteine (Hcy) levels. The objective was compare the reduction rate (RR) of Hcy and cysteine in stable dialyzed patients treated by standard HD or hemodiafiltration (HDF). Seventy-five patients undergoing stable dialysis through standard high-flux HD (n = 35) or HDF (n = 40) were included. Biological parameters were determined before and after a midweek dialysis session. Urea percent reduction per session and Kt/V index (K, body urea clearance, T, time of dialysis, and V, urea distribution volume), defined as a marker of dialysis efficacy, were similar between HD and HDF groups. By contrast, higher RR of beta2 microglobulin (β2m) was observed in HDF compared with HD (78.6 vs. 72.0%, respectively; P < 0.001). Likewise, higher RR of Hcy was obtained with HDF compared to HD (46.0 vs. 41.5%, respectively; P < 0.05), whereas the RR of cysteine was similar in both groups. Interestingly, a positive correlation between Hcy RR and urea Kt/V index was observed (r = 0.29, P < 0.05) and between Hcy RR and β2m RR (r = 0.45, P < 0.001). Time-averaged concentration (TAC) of Hcy was lower with HDF compared with HD (17.8 vs. 19.1 μmol/L, respectively), although not significant. There was no difference in median Hcy according to dialysis modality for neither pre- nor postdialysis levels. Significant higher removal of Hcy was observed with HDF compared with standard HD, although urea Kt/V index was similar. Enhanced removal of middle molecules, such as β2m, could be involved in Hcy RR improvement with HDF.
authors: CHU Montpellier, Université Montpellier, Montpellier, France.
authors: Stéphanie
authors: S
authors: Badiou
authors: Marion
authors: M
authors: Morena
authors: Anne-Sophie
authors: AS
authors: Bargnoux
authors: Isabelle
authors: I
authors: Jaussent
authors: Annie
authors: A
authors: Rodriguez
authors: Helene
authors: H
authors: Leray-Moragues
authors: Lofti
authors: L
authors: Chalabi
authors: Jean-Yves
authors: JY
authors: Bosc
authors: Bernard
authors: B
authors: Canaud
authors: Jean-Paul
authors: JP
authors: Cristol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D017583:Hemodiafiltration; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000209:etiology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D001613:beta 2-Microglobulin; D006710:Homocysteine