Citrate high volume on-line hemodiafiltration modulates serum Interleukin-6 and Klotho levels: the multicenter randomized controlled study “Hephaestus”

Pizzarelli, Francesco; Cantaluppi, Vincenzo; Panichi, Vincenzo; Toccafondi, A.; Ferrò, Giuseppe; Farruggio, Serena; Grossini, Elena; Dattolo, Pietro; Miniello, Vincenzo; Migliori, Massimiliano; Grimaldi, Cristina; Casani, Aldo; Borzumati, Maurizio; Cusinato, Stefano; Capitanini, Alessandro; Quercia, Alessandro Domenico; Filiberti, Oliviero; Dani, L

doi:10.1007/s40620-020-00943-6

Cited by 12 publications

(5 citation statements)

References 52 publications

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“…This is in accordance with previous reports by Nunez et al, who reported lower in ammatory parameters, i.e., CRP and β 2− MG using CD [36]. These results are not attributable to the dialysis technology (oL-HDF) and may suggest a potential biological effect of citrate on the CKD-associated in ammatory state [37].…”

Section: Effect On Anemiasupporting

confidence: 93%

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: Effect on clot formation and adequacy of dialysis in hemodialysis patients

Nakornchai

Jitraree

Homjan

et al. 2023

Preprint

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Background Citrate dialysate (CD) has been used successfully in conventional hemodialysis and continuous renal replacement therapy but has never been compared between pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we investigated the efficacy, metabolic changes, and quality of life of citrate anticoagulation for oL-HDF in the maintenance of hemodialysis patients in both modes. Method Eight dialysis patients were treated with CD for 4 weeks in each phase. The visual clotting scores were investigated as the primary endpoints. The adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives. Results The mean clotting scores in the pre-dilution mode were significantly lower than in the post-dilution and all phases except in the heparin-free phase (P < 0.001 in baseline phase, P = 0.001 in phase 1, and P = 0.023 in phase 2). The quality of life related to physical in the post-dilution mode was significantly higher than in the pre-dilution mode in baseline and phase 1 (P = 0.014 and 0.004 at baseline and phase 1, respectively).The metabolic changes were not different in both modes. Conclusion Citrate dialysate allows decrease or discontinuation of anticoagulation in both the pre- and post-dilution mode of oL-HDF without significant side effects.

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Section: Effect On Anemiasupporting

confidence: 93%

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: Effect on clot formation and adequacy of dialysis in hemodialysis patients

Nakornchai

Jitraree

Homjan

et al. 2023

Preprint

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“…who reported lower inflammatory parameters, that is, CRP and β 2- MG using CD [ 33 ]. These results are not attributable to dialysis technology (oL-HDF) and may suggest a potential biological effect of citrate on the CKD-associated inflammatory state [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: effect on clot formation and adequacy of dialysis in hemodialysis patients

Nakornchai,

Jitraree,

Homjan

et al. 2024

Renal Failure

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Background Citrate dialysate (CD) has been successfully used in conventional hemodialysis and continuous renal replacement therapy; however, no study has compared pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we aimed to investigate the efficacy of citrate anticoagulation for oL-HDF and the metabolic changes and quality of life of patients on hemodialysis treated using both modes Method Eight dialysis patients were treated with CD containing 0.8 mmol of citric acid for 4 weeks in each phase. Visual clotting scores were investigated as the primary endpoints. Adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives. Results The mean clotting scores in the pre-dilution mode were significantly lower than those in the post-dilution mode and in all phases except the heparin-free phase ( p < 0.001 in the baseline phase, p = 0.001 in phase 1, and p = 0.023 in phase 2). The values of Kt/V in both modalities were comparable except during the baseline phase, in which the values of pre-dilution were significantly greater than post-dilution (2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI −0.81 to −0.19, p = 0.002). The patient’s quality of life regarding their physical activity level was significantly higher in the post-dilution mode than in the pre-dilution mode at baseline and in phase 1 ( p = 0.014 and 0.004 at baseline and in phase 1, respectively). Metabolic changes did not differ between the two modes. Conclusion Citrate dialysate decreased or prevented anticoagulation in both pre- and post-dilution modes of oL-HDF without significant side effects and had comparable adequacy of dialysis.

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“…Expanded HD could remove the middle uremic toxins between 15 and 60 kDa, which include inflammatory cytokines [13,16]. However, the effectiveness of expanded HD in clearing cytokines has not been well documented, and it is unknown whether prolonged HD can lower cytokine levels.…”

Section: Discussionmentioning

confidence: 99%

Clinical Safety of Expanded Hemodialysis Compared with Hemodialysis Using High-Flux Dialyzer during a Three-Year Cohort

Cho

Jeong

Lee

et al. 2022

JCM

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Expanded hemodialysis (HD) equipped with a medium cut-off (MCO) membrane provides superior removal of larger middle molecules. However, there is still little research on the long-term benefits of expanded HD. Over a three-year period, this observational study evaluated the efficacy and safety profile of expanded HD for inflammatory cytokines, including IL-6. We conducted a prospective cohort study to investigate the inflammatory cytokine changes and a retrospective observational cohort study to investigate long-term clinical efficacy and safety over a three-year period. We categorized the patients according to dialyzer used: MCO and high-flux (HF) dialyzer. The inflammatory cytokines, including IFN-γ, IL-1β, IL-6, and TNF-α, were measured annually. The concentrations and changes of the four cytokines over time did not differ between the HF group (n = 15) and MCO group (n = 27). In both prospective and retrospective (HF group, n = 38; MCO group, n = 76) cohorts, there were no significant differences in either death, cardiovascular events, infections, or hospitalizations. Furthermore, the temporal changes in laboratory values, including serum albumin and erythropoietin prescriptions, did not differ significantly between the two groups in either the prospective or retrospective cohorts. In conclusion, clinical efficacy and safety outcomes, as well as inflammatory cytokines, did not differ with expanded HD compared with HF dialysis during a three-year treatment course, although the level of inflammatory cytokine was stable.

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Citrate high volume on-line hemodiafiltration modulates serum Interleukin-6 and Klotho levels: the multicenter randomized controlled study “Hephaestus”

Cited by 12 publications

References 52 publications

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: Effect on clot formation and adequacy of dialysis in hemodialysis patients

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: Effect on clot formation and adequacy of dialysis in hemodialysis patients

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: effect on clot formation and adequacy of dialysis in hemodialysis patients

Clinical Safety of Expanded Hemodialysis Compared with Hemodialysis Using High-Flux Dialyzer during a Three-Year Cohort

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