High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: a post-hoc analysis from the HDFit randomized controlled trial

Lima, Jordana Dinorá de; Guedes, Murilo; Rodrigues, Silvia; Flórido, Ana Clara; Moreno-Amaral, Andréa Novais; Barra, Ana Beatriz Lesqueves; Canziani, María Eugênia Fernandes; Cuvello-Neto, Américo Lourenço; Poli-de-Figueiredo, Carlos Eduardo; Pécoits-Filho, Roberto; Nakao, Lia S.

doi:10.1007/s40620-022-01283-3

Cited by 14 publications

(16 citation statements)

References 29 publications

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“…Our paper reinforces the impact of diet on UT levels and represents a shift in toxin reduction therapy. In recent years, studies aimed at reducing UTs levels have focused on dialysis techniques [24,25] and/or pro/pro/symbiotic strategies [26][27][28][29]. With our study, as well as the results of Rossi et al [21], the role of dietary intake and the quality of dietary intake on the UT level is reinforced.…”

Section: Discussionsupporting

confidence: 64%

Protein/Fiber Index Modulates Uremic Toxin Concentrations in Hemodialysis Patients

Ebersolt

Machado

Mallmann

et al. 2022

Toxins

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Background: Indoxyl sulfate (IS) and p-cresyl sulfate (PCS), two uremic toxins (UTs), are associated with increased mortality in patients with chronic kidney disease (CKD). These toxins are produced by the microbiota from the diet and excreted by the kidney. The purpose of this study was to analyze the effect of diet on IS and PCS concentration in hemodialysis (HD) patients. Methods: We performed a prospective monocentric study using a seven-day diet record and determination of serum IS and PCS levels in HD patients. We tested the association between toxin concentrations and nutritional data. Results: A total of 58/75 patients (77%) completed the diet record. Mean caloric intake was 22 ± 9.2 kcal/kg/day. The protein/fiber index was 4.9 ± 1.8. No correlation between IS or PCS concentration and protein/fiber index was highlighted. In the 18 anuric patients (31%) in whom residual renal function could not affect toxin concentrations, IS and PCS concentrations were negatively correlated with fiber intake and positively correlated with the protein/fiber index. In a multivariate analysis, IS serum concentration was positively associated with the protein/fiber index (p = 0.03). Conclusions: A low protein/fiber index is associated with low concentrations of uremic toxins in anuric HD patients. Diets with an increased fiber intake must be tested to determine whether they reduce PCS and IS serum concentrations.

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Section: Discussionsupporting

confidence: 64%

Protein/Fiber Index Modulates Uremic Toxin Concentrations in Hemodialysis Patients

Ebersolt

Machado

Mallmann

et al. 2022

Toxins

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“…17,18 Consistent with these results, maintenance hemodiafiltration has been found to cause little if any reduction in plasma levels of bound solutes as compared with conventional hemodialysis. 19,20 Experimental studies have evaluated the possibility of increasing bound solute clearances by increasing their free fraction as blood passes through the dialyzer. Their free fraction can be increased by adding a binding competitor to blood entering the dialyzer.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Increasing the Clearance of Protein-Bound Solutes by Recirculating Dialysate through Activated Carbon

Meyer,

Lee,

Whitmer

et al. 2023

Kidney360

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“…10 The removal of protein bound uremic toxins (PBUT), such as pcresylglucuronide, hippuric acid, indole acetic acid, indoxyl sulphate, p-cresyl sulphate, and 3-carboxy-4-methyl-5-propyl-furanpropionic acid, may not be improved by high-volume OL-HDF with high-flux membranes, although new evidence may suggest otherwise. 11 An explanation for the limited additive PBUT removal by post-HDF is their multicompartmental distribution with markedly low intercompartmental clearance, which reflects slow inter-compartmental transport into the plasma. 12 Removal of protein bound substances may be increased with the use of protein/albumin leaking membranes in HDF, which is not considered a standard.…”

Section: Middle Molecules and Protein Bound Uremic Toxinsmentioning

confidence: 99%

Clinical performance, intermediate and long‐term outcomes of high‐volume hemodiafiltration in patients with kidney failure

Guedes

Vernooij

Davenport

et al. 2022

Seminars in Dialysis

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Hemodiafiltration (HDF), in which both convective and diffusion methods are combined, yields an increased overall solute clearance compared with hemodialysis (HD), specifically for medium and larger molecular weight uremic toxins. Due to uncertainty in the treatment effects, the nephrology community still perceives the implementation of HDF and the achievement of high convective volume as complex.In this article, we review practical aspects of the implementation of HDF that can effectively deliver a high-volume HDF therapy and assure clinical performance to most patients. We also present an overview of the impact of high-volume HDF (compared to HD) on a series of relevant biochemical, patient-reported, and clinical outcomes, including uremic toxin removal, phosphate, Inflammation and oxidative stress, hemodynamic stability, cardiac outcomes, nutritional effects, health-related quality of life, morbidity, and mortality.

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High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: a post-hoc analysis from the HDFit randomized controlled trial

Cited by 14 publications

References 29 publications

Protein/Fiber Index Modulates Uremic Toxin Concentrations in Hemodialysis Patients

Protein/Fiber Index Modulates Uremic Toxin Concentrations in Hemodialysis Patients

Increasing the Clearance of Protein-Bound Solutes by Recirculating Dialysate through Activated Carbon

Clinical performance, intermediate and long‐term outcomes of high‐volume hemodiafiltration in patients with kidney failure

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