title: Cardiovascular protective effects of on-line hemodiafiltration: comparison with conventional hemodialysis.
abstract: Atherosclerotic complications have a significant effect on mortality in patients undergoing hemodialysis (HD) therapy. However, anti-atherosclerotic and cardioprotective effects of on-line hemodiafiltration (HDF) remain to be elucidated. We prospectively compared the anti-atherosclerotic and cardioprotective effects in two randomly divided groups, i.e. on-line HDF group (n = 13) and conventional HD group (n = 9) for 1 year. Surrogate markers were brachial-ankle pulse wave velocity (baPWV), intima-media thickness (IMT) of carotid artery as an atherosclerosis marker, and cardiac functional surrogate markers included left ventricular mass index (LVMI), ejection fraction (EF), and LV diastolic capacity represented as E/A and deceleration time (DT). LVMI in on-line HDF patients showed significant regression after 1 year of treatment (131.9 ± 25.8 to 116.5 ± 24.7 g/m(2), P = 0.03), while LVMI in HD patients did not show any significant change (148.0 ± 47.1 to 142.3 ± 35.5 g/m(2)). Levels of baPWV in HD patients showed a significant increase (11.4%) from basal levels, while on-line HDF groups showed no significant increase. Furthermore, HD patients showed significant worsening of LV diastolic capacity (E/A: from 0.87 ± 0.12 to 0.79 ± 0.08, P = 0.03), while it was not shown in on-line HDF patients. Ejection fraction and IMT did not show any significant change in both groups. Serum albumin, C-reactive protein, β2 microglobulin, blood pressure, and anti-hypertensive drug use did not change in both groups. On-line HDF showed a significant improvement in LVMI and prevented a significant worsening of baPWV or LV diastolic capacity compared with patients on conventional HD therapy.
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Shonan Kamakura General Hospital, Kamakura, Japan. ohtake@shonankamakura.or.jp
authors.forename: Takayasu
authors.initials: T
authors.lastname: Ohtake
authors.forename: Machiko
authors.initials: M
authors.lastname: Oka
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Ishioka
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Honda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mochida
authors.forename: Kyoko
authors.initials: K
authors.lastname: Maesato
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Moriya
authors.forename: Sumi
authors.initials: S
authors.lastname: Hidaka
authors.forename: Shuzo
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006440:Hemofiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*