Effect of hemodiafiltration with endogenous reinfusion on overt idiopathic chronic inflammation in maintenance hemodialysis patients: A multicenter longitudinal study

Abstract

Chronic inflammation is widely diffuse in maintenance hemodialysis (MHD) patients and is associated with poor survival. Hemodiafiltration with endogenous reinfusion (HFR) is a dialysis technique, highly biocompatible, able to adsorb proinflammatory cytokines and to decrease amino acids and antioxidants loss. These features could be helpful in MHD patients affected by idiopathic chronic inflammation, but this issue remains to be elucidated. We performed a multicenter longitudinal study to assess the effect of the switching from bicarbonate HD to HFR in patients with serum C-reactive Protein (CRP) > 5 mg/L coupled with albumin <4.0 g/dL in the last 6 months. We enrolled 24/176 (14%) patients, of which 20 patients were assessed at 4 months and 18 completed the study. We excluded 11 patients with evident causes of inflammation. At baseline, serum levels of CRP (18.7[7.0-39.4] mg/L) and albumin (3.5[3.3-3.7] g/dL) were significantly correlated (r = -0.49; P = 0.028). The effect on CRP and albumin was almost evident in the first 4 months and remained stable until to eighth month. A strict correlation (R = -0.49; 0.040) between percentage change of CRP (-35%) and albumin (+14%) after 8 months of HFR. These effects were associated with the reduction of IL-6, IL-1β, and TNF-α and the increment of pre-albumin and leptin, whereas the serum levels of Branched Chain Amino Acid (BCAA) remained unchanged. In MHD patients affected by idiopathic chronic inflammation the switching from BHD to HFR is associated with improvement of inflammation. Whether these favorable effects may modify the outcomes of these high-risk patients needs to be confirmed by studies ad hoc.

Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients

“…Indeed, we found a direct correlation between achieved convection volume and change of serum IL-6. These findings are in agreement with several studies reporting a positive effect of HDF on serum IL-6 levels [12][13][14]. However, in these early studies, the possible relationship between increased convection volume and changes in serum IL-6 levels was not investigated.…”

“…We observed also an increment of serum pre-albumin, which might depend on the improvement of negative acute reactants that may have offset the intradialytic loss occurring in HDF as previously reported [13][14][15].…”

Hemodiafiltration With Endogenous Reinfusion Improved Microinflammation and Endothelial Damage Compared With Online-Hemodiafiltration: A Hypothesis Generating Study

“…Accumulation of protein‐bound uremic toxins, inflammation, endothelial damage, and oxidative stress are known factors influencing morbidity and mortality in end‐stage renal disease patients. Thus, optimizing clearance of proinflammatory molecules by dialysis techniques is required . In conclusion, our study suggests that hemodiafiltration with endogenous reinfusion , by adsorption of the ultrafiltrate, may improve uremic protein‐bound toxin removal, inflammatory state, endothelial damage, and oxidative stress relative to online‐hemodiafiltration or high‐flux hemodialysis.…”

Removal of free light chains in hemodialysis patients without multiple myeloma: a crossover comparison of three different dialyzers

“…A recent paper by Borrelli et al reported an improvement in chronic inflammation after chronic online HFR in dialysis patients [8]. …”