Effect of Hemodialysis and Hemodiafiltration on Uremic Neuropathy

Abstract

This study was undertaken to compare the effect of 1 year hemodialysis (HD) or hemodiafiltration (HDF) treatment on peripheral neuropathy. Thus 21 of 42 patients on chronic HD (1–1.3 m² cuprophane dialyzer, Q_b 300 ml/min) were switched to HDF (1.3 m² polysulfone dialyzer, Q_b 400 ml/min, substitution volume 9-13 liters, ultrafiltration rate 60-70 ml/min), while the remaining patients were considered as a control group. Treatment time was scheduled both in HD and HDF to maintain adequate BUN levels in relation to protein catabolic rate. However, HDF provided a significantly greater weekly inulin (MW 5,000) clearance than HD (5.8 ± 1.2 vs. 1.6 ± 0.2 ml/min; p < 0.001). HD and HDF groups were comparable for age, time on dialysis and starting electroneurographic parameters, which were on average within the normal range. After 1 year follow-up, creatinine, hematocrit, calcium, phosphate, PTH, BUN, protein catabolic rate and residual GFR were comparable in the two groups, whereas β2-microglobulin was significantly reduced in HDF patients (29 ± 6.7 vs. 38.8 ± 13.9 mg/l in HD patients, p < 0.01). During the 1-year treatment, electroneurographic parameters did not change in HDF patients, whereas a significant decrease of ulnar motor nerve conduction velocity, ulnar muscle action potential amplitudes, median sensory nerve conduction velocity and peroneal muscle action potential amplitudes was detected in HD patients. We conclude that HDF might prevent the worsening of the electroneurographic indices occurring during chronic HD treatment, as it provides a more effective removal of middle and larger molecules than HD. The use of a more bio-compatible membrane in HDF might further contribute to this favorable effect on uremic neuropathy.

Effects of Hemodiafiltration and High Flux Hemodialysis on Nerve Excitability in End-Stage Kidney Disease

“…While previous studies have emphasised the role of middle molecules as a cause of nerve dysfunction in ESKD [40], [41], there was no significant correlation between PTH, a middle molecule assayed in this study, and pre-RRT measures of nerve excitability. However, while K + was closely related to pre-RRT excitability differences, it cannot explain the during and post-RRT differences between groups.…”

Signs of autonomic neuropathy in childhood uremia

“…Chronic malnutrition, anemia, hypertension, and uremic "toxins," including iPTH, are some of the factors thought to be involved [14,15]. The effect of the mode of dialysis and its efficacy on the evolution of AN has been described in adults and may suggest the role of dialyzable substances [16,17]. As following NTX normal renal function returns, the improvement of AN after transplantation would seem obvious.…”

Potassium control in chronic kidney disease: implications for neuromuscular function

“…The definition of middle molecules has been expanded to incorporate molecules that are not well removed by dialysis for other reasons, including binding moieties and multi‐compartmental behaviour . While the wide range and ambiguity of the middle molecule hypothesis has made it difficult to gain information on specific candidates for targeted therapies in uraemic neuropathy, one study has demonstrated the superiority of large‐pore dialysis membranes in the prevention of peripheral neuropathy . Several of these broad‐definition substrates, such as cytokines and advanced glycation end products, are likely to affect adversely peripheral nerve homeostasis through inflammation and vascular damage .…”