title: Online Haemodiafiltration Improves Inflammatory State in Dialysis Patients: A Longitudinal Study.
abstract: BACKGROUND
  Patients undergoing conventional hemodialysis (C-HD) present a greater immuno-inflammatory state probably related to uremia, sympathetic nervous system (SNS) activation and /or membrane bioincompatibility, which could improve with a technique-switching to online hemodiafiltration (OL-HD). The antigen-independent pathway activation of this modified immunologic state turns dendritic cells (DC) into an accurate cell model to study these patients. The aim of this study is to further evaluate the immune-inflammatory state of patients in C-HD assessed by DC maturation.
  
  
  METHODS
  31 patients were submitted to C-HD and after 4 months switched to the OL-HD technique. Monocytes-derived DCs from HD patients were cultured in the presence of IL-4/GM-CSF. DC-maturation was evaluated by assessing the maturation phenotype by flow cytometry (FACs). DCs-functional capacity to elicit T-cell alloresponse was studied by mixed leucocyte reaction. Cytokine release was assessed by FACs and SNS was evaluated measuring renalase levels by ELISA.
  
  
  RESULTS
  An up-regulation of maturation markers was observed in C-HD DCs which induced two fold more T cells proliferation than OL-HD DCs. Also, C-HD-mDCs presented with over-production of pro-inflammatory cytokines (IL-6, IL-1β, IL-8, IL-10 and TNF-α) compared with OL-HD-mDC (P<0·05). Results were correlated with clinical data. When SNS was evaluated, hypotension events and blood pressure were significantly lower and renalase levels were significantly higher after conversion to OL-HD. Diabetes mellitus type 2 patients also found beneficial reduction of mDC when converted to OL-HD compared to non-diabetics.
  
  
  CONCLUSIONS
  OL-HD could interfere with immuno-inflammatory state in HD patients with an improvement of renalase levels as potential key mediators in the mechanistic pathway of down-regulation of DC maturation.
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Ines
authors: I
authors: Rama
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Ines
authors: I
authors: Llaudó
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Pere
authors: P
authors: Fontova
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Gema
authors: G
authors: Cerezo
authors: Consorci Sanitari del Garraf. Sant Antoni Abad Hospital, Vilanova i la Geltrú, Barcelona, Spain.
authors: Carlos
authors: C
authors: Soto
authors: Department of Physiological Sciences II, School of Medicine, University of Barcelona, Barcelona, Spain.
authors: Casimiro
authors: C
authors: Javierre
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Miguel
authors: M
authors: Hueso
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Nuria
authors: N
authors: Montero
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Alberto
authors: A
authors: Martínez-Castelao
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Juan
authors: J
authors: Torras
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Josep M
authors: JM
authors: Grinyó
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Josep M
authors: JM
authors: Cruzado
authors: Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain.
authors: Nuria
authors: N
authors: Lloberas
mesh_terms: D000368:Aged; D049109:Cell Proliferation; D016207:Cytokines / Q000097:blood; D003713:Dendritic Cells / Q000166:cytology / Q000276:immunology; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000276:immunology / Q000378:metabolism; D008137:Longitudinal Studies; D008297:Male; D008995:Monoamine Oxidase / Q000378:metabolism; D013601:T-Lymphocytes / Q000166:cytology; D014511:Uremia / Q000209:etiology / Q000276:immunology
chemical_list: D016207:Cytokines; D008995:Monoamine Oxidase; C521557:renalase