title: Vitamins (A, C and E) and oxidative status of hemodialysis patients treated with HFR and HFR-Supra.
abstract: Hemodiafiltration with on-line endogenous reinfusion (HFR) is an extracorporeal dialytic method that combines diffusion, convection and adsorption. HFR-Supra (HFR-S) is a second-generation system with increased convective permeability and adsorption capability. Previous studies suggested that HFR reduces oxidative stress compared to standard haemodialysis. The principal aim of the present study was to compare antioxidant vitamins behavior and oxidative status of hemodialysis patients treated with HFR and HFR-S.
  
  
  
  The study was designed as a multicenter, randomized, crossover trial. Forty-one patients were recruited from 19 dialysis centers and after a 4-month washout stabilization period in on-line hemodiafiltration (ol-HDF), each patient was randomized to a sequence of treatments (HFR-S followed by HFR or viceversa) with each treatment applied over 6 months. Plasma levels of Advanced Oxidation Protein Products, Total Antioxidant Status, vitamins C, A and E and their ligands (Retinol Binding Protein and total lipids) were measured at baseline and at the end of each treatment period.
  
  
  
  Results show that the higher convective permeability of HFR-S with respect to HFR did not produce additional beneficial effects on the patients' oxidative status, a slight decrease of both Vitamin A and Retinol Binding Protein being the only difference registered in the long-term. However, as compared to ol-HDF, both the re-infusive techniques allowed to reduce the intradialytic loss of Vitamin C and, in the long-term, improve the patients' oxidative status and increase Retinol Binding Protein plasma values. No significant differences were found between the Vitamin C concentration of pre- and post cartridge UF neither in HFR-S nor in HFR showing that the sorbent resin does not adsorb Vitamin C.
  
  
  
  HFR-S and HFR are almost equivalent in term of impact on antioxidant vitamins and oxidative status of hemodialysis patients. Nonetheless, as compared to ol-HDF, both treatments produced a sensible sparing of Vitamin C and may represent a new approach for reducing oxidative stress and related complications in dialysis patients. Long-term effects of re-infusive treatments on patients' cardiovascular morbidity and mortality need to be evaluated.
  
  
  
  ClinicalTrials.gov Identifier NCT01492491 , retrospectively registered in 10 December 2011.
authors: Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.
authors: Simonetta
authors: S
authors: Palleschi
authors: Medical Scientific Consultant of Bellco s.r.l. Company, Mirandola, Italy.
authors: Paolo M
authors: PM
authors: Ghezzi
authors: Bellco s.r.l Company, Mirandola, Italy.
authors: Giuseppe
authors: G
authors: Palladino
authors: Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.
authors: Barbara
authors: B
authors: Rossi
authors: Ospedale A.Segni, Ozieri, Italy.
authors: Marino
authors: M
authors: Ganadu
authors: Ospedale Civile, Alghero, Italy.
authors: Domenica
authors: D
authors: Casu
authors: Ospedale SS. Annunziata, Sassari, Italy.
authors: Maria
authors: M
authors: Cossu
authors: Ospedale S. Francesco, Nuoro, Italy.
authors: Giovanni
authors: G
authors: Mattana
authors: Ospedale S. Martino, Oristano, Italy.
authors: Antonio Maria
authors: AM
authors: Pinna
authors: Ospedale N.S. della Mercede, Lanusei, Italy.
authors: Bruno
authors: B
authors: Contu
authors: ASL 3, Macomer, Italy.
authors: Tonina
authors: T
authors: Ghisu
authors: Ospedale SS. Trinità, Cagliari, Italy.
authors: Alessandro
authors: A
authors: Monni
authors: Ospedale P. Merlo, La Maddalena, Italy.
authors: Luana
authors: L
authors: Gazzanelli
authors: Ospedale N.S. di Bonaria, S. Gavino Monreale, Italy.
authors: Maria Cristina
authors: MC
authors: Mereu
authors: Ospedale S. Francesco, Nuoro, Italy.
authors: Franco
authors: F
authors: Logias
authors: Ospedale P. Dettori, Tempio Pausania, Italy.
authors: Mario
authors: M
authors: Passaghe
authors: Ospedale Infantile Regina Margherita, Torino, Italy.
authors: Alessandro
authors: A
authors: Amore
authors: Territorial Unit of Nephrology and Dialysis , ASL 8 of Cagliari, Cagliari, Italy. pg.bolasco@tin.it.
authors: Piergiorgio
authors: 0000-0001-9788-2342
authors: P
authors: Bolasco
mesh_terms: D000328:Adult; D062107:Advanced Oxidation Protein Products / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000378:metabolism*; D001205:Ascorbic Acid / Q000097:blood*; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011446:Prospective Studies; D054839:Retinol-Binding Proteins, Plasma / Q000378:metabolism; D014801:Vitamin A / Q000097:blood*; D014810:Vitamin E / Q000097:blood*; D055815:Young Adult
chemical_list: D062107:Advanced Oxidation Protein Products; D000975:Antioxidants; D008055:Lipids; D054839:Retinol-Binding Proteins, Plasma; D014801:Vitamin A; D014810:Vitamin E; D001205:Ascorbic Acid
keywords: Adsorption; Antioxidants; HFR; Hemodiafiltration; High permeability; Oxidative stress; Vitamins