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

Abstract

Hemodiafiltration with endogenous reinfusion (HFR) after ultrafiltrate passage through a resin cartridge combines adsorption, convection, and diffusion. Our prospective single-center crossover study compared HFR and online-hemodiafiltration (OLHDF) effects on two uremic toxins and 13 inflammatory, endothelial status, or oxidative stress markers. After an 8-week run-in period of high-flux hemodialysis, 17 eligible stable dialysis patients (median age 65 years, 10 male) without overt clinical inflammation were scheduled for four 8-week periods in the sequence: HFR/OLHDF/HFR/OLHDF. Relative to OLHDF, HFR was associated with greater indoxyl sulfate removal and lesser abnormalities in all other study variables, namely circulating interleukin-6, tumor necrosis factor-alpha, proportions of activated proinflammatory (CD14+CD16+, CD14++CD16+) monocytes, endothelial progenitor cells, apoptotic endothelial microparticles, vascular endothelial growth factor, vascular cellular adhesion molecule, angiopoietins 2 and 1, annexin V, and superoxide dismutase. Differences were significant (P < 0.05) in median values of 13/15 variables. Study period comparisons were generally consistent with dialysis technique comparisons, as were data from the subgroup completing all study periods (n = 9). Our investigation provides hypothesis-generating results suggesting that compared with OLHDF, HFR improves protein-bound toxin removal, inflammatory and endothelial status, and oxidative stress.

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients

“…Hemodiafiltration with regeneration of the ultrafiltrate by adsorption using a resin (Supra HFR) has been introduced as an extrarenal clearance technique that combines convection, adsorption and diffusion; it uses a high cut-off "Super High Flux" polyphenylene membrane. We have shown that hemodiafiltration with ultrafiltrate regeneration, may improve uremic protein-bound toxin removal, inflammatory state, endothelial damage, and oxidative stress as compared with on-line hemodiafiltration and high-flux hemodialysis [14]. Since a high cut-off membrane should allow the passage of FLC (especially kappa), without the loss of albumin (molecular weight 60 kD), hemodiafiltration with ultrafiltrate regeneration might be a reasonable strategy for FLC removal [15].…”

Effect of blood purification on serum miR‐126 and VEGF levels in the process of atherosclerosis in uremic patients under maintenance hemodialysis

“…Both levels tended to become normal after blood purification treatments, which is helpful to improve the function of vascular endothelial cells. In general, the accumulation of uremic toxins in MHD patients can activate inflammatory cells, resulting in micro-inflammatory status in the body [30], which would damage vascular endothelial cells and increase vascular permeability, consequently inducing up-regulation of VEGF expression and contributing to atherosclerosis [31]. According to the results of our study, there was an obvious improvement in the expression of miR-126 and VEGF with HDF treatments in MHD patients.…”

From portable dialysis to a bioengineered kidney

“…5) Hemodiafiltration with endogenous reinfusion (HFR) combining convection, adsorption and diffusion using a double-chamber system improved p-cresol removal. The ultrafiltrate, containing small amounts of albumin generated in the first chamber via a high-flux filter (sieving coefficient for albumin of 0.02), passes through a resin cartridge for PBUT removal, and is reinfused into the blood that subsequently enters a second chamber for diffusive removal via a low-flux filter [99]. 6) Combined fractionated plasma separation and adsorption, was shown to increase PBUT removal (1.3-fold increase for phenylacetic acid and p-cresol removal and 1.9-fold for IS).…”