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Hemodiafiltration With Endogenous Reinfusion Improved Microinflammation and Endothelial Damage Compared With Online‐Hemodiafiltration: A Hypothesis Generating Study
Author(s) -
EsquiviasMotta Elvira,
MartínMalo Alejandro,
Buendia Paula,
ÁlvarezLara Maria A,
Soriano Sagrario,
Crespo Rodolfo,
Carracedo Julia,
Ramírez Rafael,
Aljama Pedro
Publication year - 2017
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12704
Subject(s) - hfr cell , fibrinogen , proinflammatory cytokine , annexin a5 , oxidative stress , dialysis , medicine , hemodialysis , andrology , tissue factor , endothelium , inflammation , immunology , annexin , chemistry , flow cytometry , biochemistry , coagulation , escherichia coli , gene
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.