Post-Dilution High Convective Transport Improves Microinflammation and Endothelial Dysfunction Independently of the Technique

Abstract

Background/Aims: We examined the effects of different online hemodiafiltration techniques on microinflammation and endothelial damage/repair. Methods: The study was designed as a prospective crossover study. Flow cytometry was used to measure CD14⁺CD16⁺ monocytes, apoptotic endothelial microparticles (EMPs), and endothelial progenitor cells (EPCs). Results: Patients treated with high-flux hemodialysis showed a marked chronic inflammatory state (HF-HD 11 ± 2) versus healthy subjects (HS 3.9 ± 2.3; p < 0.05). High convective transport, independent of the technique used, improves microinflammatory parameters (OL-HDF 7.3 ± 2.1 or MID 6.5 ± 3.4; p < 0.05) and the endothelial damage/repair balance compared to HF-HD (EPCs HF-HD 0.3 ± 0.2), with no differences found between the two modalities (EPCs OL-HDF 0.6 ± 0.1, MID 0.6 ± 0.2; p < 0.05). Conclusion: An increase in convective transport improves the microinflammatory state and the endothelial damage/repair of these patients independently of the technique used.

T-Cell Activation and Malnutrition Adversely Impact on Endothelial Progenitor Cell Mobilization in Patients on Extracorporeal Maintenance Dialysis Therapy

“…On contrary, CD14+ CD16+ monocytes subsets that are observed in high proportion in CKD patients may be involved in vascular impairment [34] . An inverse correlation between CD14+ CD16+ level and EPCs number has been observed [35][36][37] . Our results are in line with these observations, suggesting that both circulating pro-inflammatory monocytes and activated T cells are associated with a poor mobilization of EPCs.…”

“…Using this study design each patient acted as his own control, which improves reproducibility and facilitates explorations of biological modifications associated with dialysis modalities. Previous studies have observed the reduction of the percentage of proinflammatory CD14+ CD16+ monocytes using high-flux one line hemofiltration [34,35,37] . This reduction of microinflammation may improve EPCs mobilization and endothelial damage/repair imbalance.…”

“…This reduction of microinflammation may improve EPCs mobilization and endothelial damage/repair imbalance. Authors have recently reported a rise of CD34+/CD133+/KDR+ cells alongside with a reduction of endothelial microparticles number after the shift from high-flux HD to HDF with high convective transport post-dilution [37] . In another cross-over study, authors were unable to demonstrate a different effect of high-flux HD versus HDF on circulating EPC number [7] .…”

“…Our results are in line with these observations, suggesting that both circulating pro-inflammatory monocytes and activated T cells are associated with a poor mobilization of EPCs. CD14+ CD16+ cells have enhanced capacity to secret proinflammatory TNF-α and IL-6 cytokines [37] . Inflammatory cytokine produced by macrophages may trigger T-cell activation via a bystander mechanism without engagement of the T-cell receptor.…”

Análisis comparativo entre hemodiafiltración en línea frente a hemodiafiltración con reinfusión endógena: parámetros clínico-técnicos e inflamatorios

“…Este proceso inflamatorio mejora con la utilización de técnicas alternativas a la HD convencional como es la hemodiafiltración en línea (HDF-OL), que consigue mejorar los aclaramientos de toxinas urémicas al aumentar esta técnica el transporte convectivo [4][5][6] . Para la realización de esta técnica, es necesario la utilización de una membrana de alto flujo, capaz de mantener durante la sesión una ultrafiltración elevada en ausencia de complicaciones técnicas en el circuito extracorpóreo, al mismo tiempo que se requiere el suministro de líquido de reposición para compensar el exceso A comparative analysis between online hemodiafiltration and hemodiafiltration with endogenous reinfusion: clinical, technical and inflammatory parameters.…”