Acute Effects of Hemodiafiltration Versus Conventional Hemodialysis on Endothelial Function and Inflammation: A Randomized Crossover Study.
Endothelial dysfunction and chronic inflammatory process are prevalent in patients with end-stage renal disease (ESRD) on maintenance hemodialysis (HD). The aim of this study was to evaluate the acute and short-term effects of online hemodiafiltration (OL-HDF) versus conventional HD on endothelial function and inflammation. A prospective, randomized, crossover trial. Twenty stable ESRD patients undergoing chronic HD treatments were randomly assigned with a 1:1 ratio to conventional HD and to OL-HDF both for 2 weeks (either HD followed by OL-HDF or OL-HDF followed by HD). Markers of endothelial dysfunction such as flow-mediated dilatation (FMD) of the brachial artery, soluble endothelial protein C receptor (sEPCR), and soluble thrombomodulin (sTM) were measured at baseline, after the first dialysis session and after 2 weeks. Meanwhile, serum interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) levels were measured as well. Both a single OL-HDF session and 2-week OL-HDF significantly improved brachial FMD% (18.7 ± 6.9% at baseline; 21.5 ± 5.4% after the first dialysis; 21.5 ± 5.7% after 2 weeks; P < 0.05 vs baseline), decreased the levels of sEPCR (from 394.4 [297.9-457.0] ng/ml at baseline to 234.7 [174.1-345.5] ng/ml after the first dialysis, and to 191.5 [138.2-255.0] ng/ml after 2 weeks; P < 0.01 vs baseline) and sTM. In contrast, HD did not change FMD%, even increased the levels of sEPCR and sTM. A reduction in IL-6 level was observed in OL-HDF patients after 2-week dialysis, while IL-6 did not change in HD patients. There was no significant difference in change of hs-CRP level between the OL-HDF and HD treatments. OL-HDF has both acute and short-term beneficial effects on endothelial dysfunction compared to conventional HD.
From the Division of Nephrology, Zhongshan Hospital, Fudan University (PJ, WJ, JT, HZ, JZ, ZL, BS, XC, XD), Kidney and Dialysis Institute of Shanghai (PJ, XD), Kidney and Blood Purification Laboratory of Shanghai (PJ, XD), and Division of Nephrology, Central Hospital of Minhang District, Shanghai, China (WJ).
Ping
P
Jia
Wei
W
Jin
Jie
J
Teng
Hao
H
Zhang
Jianzhou
J
Zou
Zhonghua
Z
Liu
Bo
B
Shen
Xuesen
X
Cao
Xiaoqiang
X
Ding
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D018592:Cross-Over Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D016037:Single-Blind Method; D013997:Time Factors; D014664:Vasodilation / Q000502:physiology*; D055815:Young Adult
D015415:Biomarkers