Circulating endotoxaemia and frequent haemodialysis schedules.
OBJECTIVE
Endotoxaemia, a driver of systemic inflammation, appears to be driven by dialysis-induced circulatory stress in haemodialysis (HD) patients. More frequent HD regimens are associated with lower ultrafiltration requirements, improved haemodynamic stability and lower systemic inflammation. This study investigated the hypothesis that more frequently dialysed patients, with reduced exposure to dialysis-induced haemodynamic perturbation, would have lower circulating endotoxin (ET) levels.


METHODS
A cross-sectional study of 86 established HD patients compared three groups: conventional HD 3× per week (HD3, n = 56), frequent HD 5-6× per week (SDHD, n = 20), and nocturnal HD (NHD, n = 10). Data collection included ultrafiltration volume and rate, serial blood pressures and blood sampling with quantification of ET, troponin T and high-sensitivity CRP (hsCRP).


RESULTS
Pre-dialysis serum ET was highest in the conventional HD group (HD3 0.66 ± 0.29 EU/ml vs. NHD 0.08 ± 0.04 EU/ml). Across the study population, severity of endotoxaemia was associated with higher ultrafiltration rates, degree of intradialytic hypotension, troponin T and hsCRP levels. NHD patients had the lowest ultrafiltration requirements, the greatest haemodynamic stability and lower ET levels.


CONCLUSIONS
More frequent HD regimens are associated with lower levels of circulating ET compared with conventional HD. Reduced ET translocation may be related to the greater haemodynamic stability of these treatments, with superior maintenance of splanchnic perfusion.
Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
Helen J
HJ
Jefferies
Lisa E
LE
Crowley
Laura E A
LE
Harrison
Cheuk-Chun
CC
Szeto
Philip K T
PK
Li
Brigitte
B
Schiller
John
J
Moran
Christopher W
CW
McIntyre
D003430:Cross-Sectional Studies; D019446:Endotoxemia / Q000097:blood* / Q000517:prevention & control*; D004731:Endotoxins / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D006435:Renal Dialysis / Q000379:methods* / Q000706:statistics & numerical data*; D020107:Troponin T / Q000097:blood
D004731:Endotoxins; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain