title: A single dialysis session of hemodiafiltration with sorbent-regenerated endogenous ultrafiltrate reinfusion (HFR) removes hepcidin more efficiently than bicarbonate hemodialysis: a new approach to containing hepcidin burden in dialysis patients?
abstract: Most hemodialysis patients have high Hepcidin-25 levels, which may be involved in the pathogenesis of several uremic complications related to an altered iron biology. The hemodialysis procedure itself can influence Hepcidin-25 levels by removing Hepcidin-25 and maybe stimulating its production due to a pro-inflammatory effect.
  
  
  
  To assess the relationship between dialysis-related inflammation and intradialysis changes in Hepcidin-25, we performed a crossover trial in 28 hemodialysis patients to compare the effects on serum levels of Hepcidin-25 and inflammatory markers activated during dialysis [Tumor Necrosis Factor-α (TNF-α), Interleukin-6, C-reactive protein (CRP), Pentraxin-3] of a single dialysis session using a technique capable of reducing inflammation, HFR (Hemo Filtrate Reinfusion: a hemodiafiltration system combining convection, diffusion and adsorption) or bicarbonate-dialysis using either the same low-flux membrane as in the diffusion stage of HFR (LFBD) or a high-flux membrane (HFBD).
  
  
  
  HFR achieved a greater reduction in Hepcidin-25 levels than both LFBD [-72% (95% CI: -11 to -133), p = 0.022] and HFBD [-137% (95% CI: -2 to -272), p = 0.047], conceivably due to both a greater removal (because of its convective/adsorptive component) and a lower inflammation-related Hepcidin-25 production. HFR also led to a greater decrease in TNF-α than LFBD [-277% (95% CI: -59 to -494), p = 0.014], while the two methods induced similar changes in Interleukin-6, CRP and Pentraxin-3 levels.
  
  
  
  Our findings suggest that a single bicarbonate-dialysis session can upregulate Hepcidin-25 synthesis and that HFR can fully overcome this effect, enabling a greater Hepcidin-25 removal during dialysis. Adequately-designed studies are needed, however, to establish whether the beneficial effect of HFR emerging from our study could reduce Hepcidin-25 (and TNF-α) burden and improve clinically-relevant outcomes.
  
  
  
  ISRCTN15957905.
authors.affiliation: Emodialisi Borgo Roma, Nephrology Section, Department of Medicine, University of Verona, Piazzale LA Scuro 10, 37134, Verona, Italy. nicola.tessitore@aovr.veneto.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Tessitore
authors.affiliation: Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
authors.forename: Albino
authors.initials: A
authors.lastname: Poli
authors.affiliation: Emodialisi Borgo Roma, Nephrology Section, Department of Medicine, University of Verona, Piazzale LA Scuro 10, 37134, Verona, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Bedogna
authors.affiliation: Bellco srl, Mirandola, MO, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Corazza
authors.affiliation: Internal Medicine Section, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Natascia
authors.initials: N
authors.lastname: Campostrini
authors.affiliation: Bellco srl, Mirandola, MO, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Atti
authors.affiliation: Bellco srl, Mirandola, MO, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Sereni
authors.affiliation: Internal Medicine Section, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Castagna
authors.affiliation: Internal Medicine Section, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Girelli
authors.affiliation: Emodialisi Borgo Roma, Nephrology Section, Department of Medicine, University of Verona, Piazzale LA Scuro 10, 37134, Verona, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Pessolano
authors.affiliation: Emodialisi Borgo Roma, Nephrology Section, Department of Medicine, University of Verona, Piazzale LA Scuro 10, 37134, Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lupo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates; D002097:C-Reactive Protein / Q000378:metabolism; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015312:Hemodialysis Solutions; D064451:Hepcidins / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D000683:Serum Amyloid P-Component / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D000099153:Pentraxins
chemical_list: D001639:Bicarbonates; D002097:C-Reactive Protein; D015312:Hemodialysis Solutions; D064451:Hepcidins; D015850:Interleukin-6; D000683:Serum Amyloid P-Component; D014409:Tumor Necrosis Factor-alpha; D000099153:Pentraxins; C508600:IL6 protein, human; C545475:hepcidin 25, human
keywords: Bicarbonate-dialysis; Hemo Filtrate Reinfusion (HFR); Hepcidin-25; Pro-inflammatory cytokines