Evaluation of a Novel Vitamin E Coated Cellulosic Membrane Hollow Fiber Dialyzer

Abstract

Adverse physiologic effects accompany hemodialysis. Biocompatible dialyzer membranes may both limit oxidative stress and decrease beta2-microglobulin production, thereby reducing patient morbidity. We compared standard solute clearance, lipid, and antioxidant effects of a novel cellulosic membrane dialyzer modified with covalently bonded vitamin E (Excebrane Clirans E15, Terumo Australia) with standard cellulosic and polysulphone membrane dialyzers. Stable adult hemodialysis patients taking no lipid lowering or antioxidant therapy (n = 17; 9 male, 8 female) were recruited into a 10 week, prospective, unblinded study. Measurements were made at baseline on their usual dialyzer and after 2, 4, and 10 weeks of Excebrane use. Excebrane demonstrated good in vivo clearance of standard solutes relative to surface area. Predialysis beta2-microglobulin levels were unchanged with time and were significantly lower postdialysis than with cellulose acetate (p < 0.05). Oxidized low density lipoprotein levels as measured by nitrotyrosine residues were high predialysis, but tended to decrease with both membranes (p > 0.05). Total antioxidant status fell during dialysis (p < 0.0005), but plasma vitamin A and E concentrations increased (p = 0.007 and p = 0.02, respectively). Baseline vitamin A levels were high in all patients and, along with vitamin E, total antioxidant status and lipid profiles did not change over time with Excebrane use. Excebrane is an efficient, biocompatible membrane with no deleterious effects on beta2-microglobulin or lipids. More long-term study is merited.

Is Routine Multivitamin Supplementation Necessary in US Chronic Adult Hemodialysis Patients? A Systematic Review

“…These findings have been replicated in several other studies performed outside the US 55,57,61,62 , though not all concur 58 .…”

“…While there are no studies of vitamin A in the U.S. hemodialysis population, studies from Europe and Australia [55][56][57][58][59] reported that vitamin A levels in chronic hemodialysis patients were generally within the normal range and frequently at least as high, if not higher, than healthy controls.…”

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

“…Six studies [11,16,26,30,49,63] focused on blood vitamin C levels. Variation in plasma oxidized low density lipoprotein (Ox-LDL), nitric oxide (NOx) and thiobarbituric acid reactive substances (TBARS) were given in 11 [18,19,24,25,46,48,51,56,65,67,70] , 4 [16,22,57,62] and 8 studies [20,26,29,33,39,44,47,70] , respectively. Thirteen studies [10,20,23,26,30,33,44,48,49,51,58,64,70] reported information on total anti-oxidant status (TAS) and anti-oxidant capacity (AOC).…”

“…8 b) [10,20,26,44,48,49,51,64,70] . Three studies [23,33,58] reported results that were in line with such findings.…”

Is the Bioreactivity of Vitamin-E-Modified Dialyzer an Expression of Increased Plasmatic Vitamin E Concentration?

“…The positive biochemical effects of this type of membrane, as well as its positive immunochemical effects such as protecting HD patients against OFR damage by decreasing polymorphonuclear cells activation and providing a better control of the blood lipoperoxidation and antioxidant status, apoptosis and respiratory burst on mononuclear cells [4, 5], are dependent on increased plasmatic vitamin E concentration? The substantial enrichment of plasma with vitamin E after use of CL-E membranes in comparison with conventional membranes observed in other experiments [2, 6], but not accepted by general consent, is the major observation of our study.…”