title: Online hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis.
abstract: Online hemodiafiltration may diminish inflammatory activity through amelioration of the uremic milieu. However, impurities in water quality might provoke inflammatory responses. We therefore compared the long-term effect of low-flux hemodialysis to hemodiafiltration on the systemic inflammatory activity in a randomized controlled trial. High-sensitivity C-reactive protein and interleukin-6 were measured for up to 3 years in 405 patients of the CONvective TRAnsport STudy, and albumin was measured at baseline and every 3 months in 714 patients during the entire follow-up. Differences in the rate of change over time of C-reactive protein, interleukin-6, and albumin were compared between the two treatment arms. C-reactive protein and interleukin-6 concentrations increased in patients treated with hemodialysis, and remained stable in patients treated with hemodiafiltration. There was a statistically significant difference in rate of change between the groups after adjustments for baseline variables (C-reactive protein difference 20%/year and interleukin-6 difference 16%/year). The difference was more pronounced in anuric patients. Serum albumin decreased significantly in both treatment arms, with no difference between the groups. Thus, long-term hemodiafiltration with ultrapure dialysate seems to reduce inflammatory activity over time compared to hemodialysis, but does not affect the rate of change in albumin.
authors.affiliation: 1] Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands [2] Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Claire H
authors.initials: CH
authors.lastname: den Hoedt
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: 1] Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands [2] Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Muriel P C
authors.initials: MP
authors.lastname: Grooteman
authors.affiliation: Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Neelke C
authors.initials: NC
authors.lastname: van der Weerd
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Albert H A
authors.initials: AH
authors.lastname: Mazairac
authors.affiliation: Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: E Lars
authors.initials: EL
authors.lastname: Penne
authors.affiliation: Department of Nephrology, St Luc Hospital, Montréal, Canada.
authors.forename: Renée
authors.initials: R
authors.lastname: Levesque
authors.affiliation: 1] Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands [2] Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Piet M
authors.initials: PM
authors.lastname: ter Wee
authors.affiliation: 1] Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands [2] Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Menso J
authors.initials: MJ
authors.lastname: Nubé
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Marinus A
authors.initials: MA
authors.lastname: van den Dorpel
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012709:Serum Albumin / Q000378:metabolism; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology / Q000517:prevention & control
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D012709:Serum Albumin; D002097:C-Reactive Protein