title: Hemodiafiltration With Endogenous Reinfusion Improved Microinflammation and Endothelial Damage Compared With Online-Hemodiafiltration: A Hypothesis Generating Study.
abstract: Hemodiafiltration with endogenous reinfusion (HFR) after ultrafiltrate passage through a resin cartridge combines adsorption, convection, and diffusion. Our prospective single-center crossover study compared HFR and online-hemodiafiltration (OLHDF) effects on two uremic toxins and 13 inflammatory, endothelial status, or oxidative stress markers. After an 8-week run-in period of high-flux hemodialysis, 17 eligible stable dialysis patients (median age 65 years, 10 male) without overt clinical inflammation were scheduled for four 8-week periods in the sequence: HFR/OLHDF/HFR/OLHDF. Relative to OLHDF, HFR was associated with greater indoxyl sulfate removal and lesser abnormalities in all other study variables, namely circulating interleukin-6, tumor necrosis factor-alpha, proportions of activated proinflammatory (CD14+CD16+, CD14++CD16+) monocytes, endothelial progenitor cells, apoptotic endothelial microparticles, vascular endothelial growth factor, vascular cellular adhesion molecule, angiopoietins 2 and 1, annexin V, and superoxide dismutase. Differences were significant (P < 0.05) in median values of 13/15 variables. Study period comparisons were generally consistent with dialysis technique comparisons, as were data from the subgroup completing all study periods (n = 9). Our investigation provides hypothesis-generating results suggesting that compared with OLHDF, HFR improves protein-bound toxin removal, inflammatory and endothelial status, and oxidative stress.
authors.affiliation: Nephrology Unit, Reina Sofía University Hospital, Córdoba.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.
authors.forename: Elvira
authors.initials: E
authors.lastname: Esquivias-Motta
authors.affiliation: Nephrology Unit, Reina Sofía University Hospital, Córdoba.|Instituto de Salud Carlos III (RETICs Red Renal), Madrid.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Martín-Malo
authors.affiliation: Instituto de Salud Carlos III (RETICs Red Renal), Madrid.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.
authors.forename: Paula
authors.initials: P
authors.lastname: Buendia
authors.affiliation: Nephrology Unit, Reina Sofía University Hospital, Córdoba.|Instituto de Salud Carlos III (RETICs Red Renal), Madrid.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Álvarez-Lara
authors.affiliation: Nephrology Unit, Reina Sofía University Hospital, Córdoba.|Instituto de Salud Carlos III (RETICs Red Renal), Madrid.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.
authors.forename: Sagrario
authors.initials: S
authors.lastname: Soriano
authors.affiliation: Nephrology Unit, Reina Sofía University Hospital, Córdoba.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Crespo
authors.affiliation: Instituto de Salud Carlos III (RETICs Red Renal), Madrid.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.
authors.forename: Julia
authors.initials: J
authors.lastname: Carracedo
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.|Biologia de Sistemas Department, Alcala de Henares University, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramírez
authors.affiliation: Nephrology Unit, Reina Sofía University Hospital, Córdoba.|Instituto de Salud Carlos III (RETICs Red Renal), Madrid.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Córdoba.
authors.forename: Pedro
authors.initials: P
authors.lastname: Aljama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004727:Endothelium / Q000276:immunology / Q000473:pathology; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood; D018950:Lipopolysaccharide Receptors / Q000032:analysis / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D018384:Oxidative Stress; D011446:Prospective Studies; D017452:Receptors, IgG / Q000032:analysis / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000276:immunology; D014511:Uremia / Q000628:therapy
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D018950:Lipopolysaccharide Receptors; D017452:Receptors, IgG; D014409:Tumor Necrosis Factor-alpha
keywords: Adsorption; Hemodiafiltration with endogenous reinfusion; Inflammation; Online-hemodiafiltration; Uremic toxins; endothelial dysfunction