Effects of vitamin E-coated dialysis membranes on anemia, nutrition and dyslipidemia status in hemodialysis patients: a meta-analysis

Abstract

Background: This was controversial whether vitamin E-coated dialyzer therapy was beneficial for the complications associated with hemodialysis. Therefore, we performed this systematic review to evaluate the effects of vitamin E-coated dialyzer. Methods: Related trials were searched from multiple electronic databases. We conducted meta-analysis to assess changes in the predefined outcomes using RevMan 5.3 software. Results: Meta-analysis showed vitamin E-coated dialyzer therapy could decrease erythropoietin (EPO) resistance index (SMD, À0.24; 95% CI, À0.47 to À0.01; p ¼ 0.04). However, pooled-analysis showed vitamin E-coated dialyzer therapy could not decrease weekly EPO dose (SMD, À0.11; 95% CI, À0.32 to 0.09; p ¼ 0.28) and intima-media thickness (IMT) of the carotid artery (MD, À0.09; 95% CI, À0.2 to 0.01; p ¼ 0.09), and vitamin E-coated dialyzer therapy did not improve the serum hemoglobin (MD, À0.03; 95% CI, À0.18 to 0.13; p ¼ 0.74), albumin levels (SMD, À0.64; 95% CI, À1.62 to 0.34; p ¼ 0.2), in addition, there was no significant difference in serum cholesterol (SMD, À0.07; 95% CI, À0.45 to 0.31; p ¼ 0.71), triglycerides (MD, À2.77; 95% CI, À32.42 to 26.87; p ¼ 0.85), high density lipoprotein (HDL) (SMD, 0.24; 95% CI, À0.14 to 0.62; p ¼ 0.22) and low density lipoprotein (LDL) (SMD, 0.00; 95% CI, À0.38 to 0.37; p ¼ 0.98) levels. Conclusions: Vitamin E-coated dialyzer may reduce the EPO resistance, but there is no conclusive evidence that vitamin E-coated dialyzer can improve the renal anemia, malnutrition, dyslipidemia and atherosclerosis status in hemodialysis (HD) patients. However, high-quality trials with hard clinical endpoints are required to fully elucidate the clinical value of vitamin E-coated dialyzer therapy.

Effects of Vitamin E-Coated versus Conventional Membranes in Chronic Hemodialysis Patients: A Systematic Review and Meta-Analysis

“…The absence of effect on such parameters was in agreement with previous analyses focusing on fewer studies [7] .…”

“…Finally, in line with previous meta-analyses [7] , our results confirmed that the use of ViE-m did not influence other parameters of interest for dialysis patients, such as dialysis adequacy, lipid profile, intradialytic blood pres- sure, dialysis adequacy, serum albumin, uric acid and WBC count. Our review has some points of strength and also a few limitations that deserve to be mentioned.…”

“…This observation echoes previous findings based on fewer studies [7] and may have relevant clinical value, as ESA-resistance represents a major obstacle for anemia control in dialysis patients. Alternative therapeutic strategies for improving resistance to ESAs may be of foremost importance also for saving costs and improving other patient-centered outcomes.…”

“…Previous pooled analyses demonstrated that vitamin E-coated membranes (ViE-m) may improve various surrogate parameters pertaining to oxidative stress, inflammation, anemia and nutritional status [7][8][9] . In particular, as ViE-m seems to ameliorate the response to erythropoiesis stimulating agents (ESAs) and to protect red blood cell (RBC) by increasing RBC vitamin-E levels, it has been postulated that these membranes could be useful in daily practice for sparing ESAs in chronic HD patients [10,11] .…”

Anemia in conventional hemodialysis: Finding the optimal treatment balance

“…Other interventions for improving hyporesponsiveness to ESA treatment have been proposed. A systematic review suggested that a vitamin E‐coated dialyzer may reduce ESA resistance . Recently, we examined if statin prescriptions would improve ESA hyporesponsiveness using the Japan DOPPS cohort, and suggested that statins may slightly reduce ESA hyporesponsiveness in patients undergoing HD …”