Effect of a More Permeable Dialysis Membrane on ESA Resistance in Hemodialysis Patients - A Pilot Investigation

Teatini, Ugo; Liebchen, Ariane; Nilsson, Lars‐Göran; Beck, Werner; Longhena, Giorgio Romei

doi:10.1159/000441437

Cited by 9 publications

(11 citation statements)

References 26 publications

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“…Also Stefansson et al [34], in a short-term study consisting of a small population of 20 patients, suggested that hepcidin levels were significantly reduced after 60 days of high volume OL-HDF with respect to low-flux HD. The role of membrane permeability in removing high quantity of hepcidin and in reducing its pre-HD levels has been confirmed by Teatini et al [35] using a high cut-off membrane. In the study group, 50% reduction on hepcidin level was achieved and it was associated with an increase of hemoglobin level.…”

Section: Current Strategies To Improve Esa Hyporesponsivenessmentioning

confidence: 83%

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

2018

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Hyporesponsiveness to erythropoietin stimulating agents (ESAs) is a condition associated with increased mortality. Even after identifying the condition, the causes are difficult to treat and only partially reversible in end-stage renal disease patients. Thus, the role of more recent hemodialysis (HD) techniques in improving such conditions is an emerging issue. However, major randomized clinical trials have not confirmed the results of smaller observational studies in which online hemodiafiltration has shown some efficacy in improving patients’ response to ESAs. In our interpretation, these findings are not in contrast, but they can be explained by a better understanding of the interactions between HD and ESAs on iron mobilization, first of all through the role of hepcidin. The kinetics of hepcidin removal through HD combined with the action of selected ESAs may help the clinician in prescribing the best association between HD treatment and ESAs to overcome hyporesponsiveness.

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Section: Current Strategies To Improve Esa Hyporesponsivenessmentioning

confidence: 83%

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

2018

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“…Most recently, an innovation called expanded hemodialysis (HDx), which uses an MCO membrane that allows for improved removal of molecules with a size of 25 kDa and above, including larger uremic toxins. Furthermore, expanded hemodialysis can be used with the same process and personnel as HD, which means that it can be implemented with relatively low costs, and early clinical evidence suggests that using HDx has the potential to improve patient outcomes and quality of life [ 11 , 12 ]. However, evidence of the potential economic value of using of HDx remains limited.…”

Section: Introductionmentioning

confidence: 99%

An initial evaluation of expanded hemodialysis on hospitalizations, drug utilization, costs, and patient utility in Colombia

Ariza

Walton

Suarez³

et al. 2021

Ther Apher Dial

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To examine new evidence linking expanded hemodialysis (HDx) using a medium cut-off (MCO) membrane with hospitalizations, hospital days, medication use, costs, and patient utility. This retrospective study utilized data from Renal Care Services medical records database in Colombia from 2017 to 2019.Clinics included had switched all patients from high flux hemodialysis (HD HF) to HDx and had at least a year of data on HD HF and HDx. Data included demographic characteristics, comorbidities, years on dialysis, hospitalizations, medication use, and quality of life measured by the 36 item and Short Form versions of the Kidney Disease Quality of Life survey at the start of HDx, and 1 year after HDx, which were mapped to EQ-5D utilities. Generalized linear models were run on the outcomes of interest with an indicator for being on HDx. Annual cost estimates were also constructed. The study included 81 patients. HDx was significantly associated with lower dosing of erythropoietin stimulating agents, iron, hypertension medications, and insulin. HDx was also significantly associated with lower hospital days per year (5.94 on HD vs. 4.41 on HDx) although not with the number of hospitalizations. Estimates of annual hospitalization costs were 23.9% lower using HDx and patient utilities did not appear to decline. HDx was statistically significantly associated with reduced hospitalization days and lower medication dosages. Furthermore, this preliminary analysis suggested potential for HDx being a dominant strategy in terms of costs and utility and should motivate future work with larger samples and better controls.

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“…Using high volume OL-HDF, Stefansson et al obtained a significant (38%) reduction of serum hepcidin levels after 60 days of treatment (34). In turn, in the Teatini et al study, the use of high cutoff membrane confirmed the removal of a high quantity of hepcidin and a 50% reduction its pre-dialysis serum level (35). The application of convective transport and good membrane permeability appears to be the solution to obtain lower levels of hepcidin in dialysis patients; however, it should be confirmed in future large-scale studies.…”

Section: Hepcidin In Chronic Kidney Diseasementioning

confidence: 93%

Iron and Chronic Kidney Disease: Still a Challenge

2020

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Anemia is a clinical feature of chronic kidney disease (CKD). Most common causes are iron and erythropoietin deficiency. The last two decades have yielded significant advances in understanding iron balance's physiology, including iron trafficking and the crosstalk between iron, oxygen, and erythropoiesis. This knowledge sheds new light on the regulation and disturbance of iron homeostasis in CKD and holds the promise for developing new diagnostic and therapeutic tools to improve the management of iron disorders. Hepcidin–ferroportin axis has a central role in regulating body iron balance and coordinating communication between tissues and cells that acquire, store, and utilize iron. Recent research has revealed a bidirectional relationship between fibroblast growth factor 23 (FGF23) and iron status, anemia, and inflammation, as well as the role of erythroferrone (ERFE) in iron homeostasis. However, ERFE concentrations and actions are not well-characterized in CKD patients. Studies on ERFE in CKD are limited with slightly conflicting results. Despite general interest in iron metabolism in kidney diseases, studies on the less prevalent renal replacement therapy mode, such as peritoneal dialysis or hemodiafiltration, are scarce. Slightly more was published on hemodialysis. There are several novel options on the horizon; however, clinical data are limited. One should be aware of the potential risks and benefits of the novel, sophisticated therapies. An inhibition of hepcidin on the different pathways might be also a viable adjunctive therapeutic option in other clinical situations.

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Effect of a More Permeable Dialysis Membrane on ESA Resistance in Hemodialysis Patients - A Pilot Investigation

Cited by 9 publications

References 26 publications

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

An initial evaluation of expanded hemodialysis on hospitalizations, drug utilization, costs, and patient utility in Colombia

Iron and Chronic Kidney Disease: Still a Challenge

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