Prospective randomized pilot study on the effects of two synthetic high-flux dialyzers on dialysis patient anemia.
OBJECTIVE
Anemia in chronic kidney disease dialysis patients is a complex syndrome involving many causes. Adequate dialysis can contribute to its correction through many mechanisms, including the removal of molecules that may inhibit erythropoiesis. The aim of this pilot study was to evaluate the effect on renal anemia of two synthetic, high-flux dialyzers (polynephron vs. high-flux polysulphone).


METHODS
20 dialysis patients (11 male; mean age: 72 years) were randomly assigned and studied for 6 months. There were 2 dropouts in each group. Each patient underwent 3 hemodialysis treatments per week without any difference in dialysis prescription. At T = 0 and T = 6 (after 6 months), instantaneous plasma clearances and reduction rates of small solutes, ß2-microglobulin protein (ß2-µ); hemoglobin (Hb), and iron pattern were measured. The effect on anemia was evaluated by calculating the Erythropoesis Stimulating Agent (ESA) doses and the Erythropoietin Resistance Index (ERI).


RESULTS
Kt/V increased between T0 and T6 in both groups. ß2-µ pre-dialysis levels significantly decreased between T0 and T6 in both dialyzer groups (p<0.001 in both groups). The Hb levels increased between T0 and T6, but significantly only for the polynephron patient group (p = 0.006 and 0.142). ESA dose did not change significantly. The ERI decreased by 22.7% between T0 and T6 in the polynephron-group and increased by 14% in the others; these changes were not significant.


CONCLUSIONS
High-flux filters improved Hb levels, although only significantly in the polynephron group, suggesting a possible different effect. The results should be interpreted with caution and tested in an appropriately powered, large, prospective, randomized control trial.
Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco - Italy. sm.vigano@ospedale.lecco.it
Sara M
SM
Viganò
Salvatore Di
SD
Filippo
Vincenzo La
VL
Milia
Giuseppe
G
Pontoriero
Francesco
F
Locatelli
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D004867:Equipment Design; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007558:Italy; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010865:Pilot Projects; D011108:Polymers; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D013450:Sulfones; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700