Predilution On-Line Hemodiafiltration Improves Albumin Redox in Maintenance Hemodialysis Patients

Abstract

Background/Aim: In this study, we compared the dialysis efficiency, oxidative stress, and nutritional conditions between predilution on-line hemodiafiltration (pre-OL-HDF) and conventional hemodialysis (HD) using a super-flux dialyzer (CHD). Method: This was a crossover study of 38 maintenance HD patients. All patients were treated with CHD for the first 4 months (1st CHD period), then were switched to pre-OL-HDF for 4 months (pre-OL-HDF period), and were returned to CHD for the next 4 months (2nd CHD period). Results: We found no significant difference in the removal ratio of small uremic substances or the indices of inflammation or nutritional states between the pre-OL-HDF and CHD periods. However, we found higher removal of β2 micro-globulin in the pre-OL-HDF period, and the human mercapto-albumin (Alb)/human serum Alb ratio was significantly higher in the pre-OL-HDF period. Conclusion: Treatment with pre-OL-HDF enabled enhanced removal of middle molecule uremic toxins and better Alb redox than did CHD.

Non-mercaptalbumin is Significantly Associated with the Coronary Plaque Burden and the Severity of Coronary Artery Disease

“…Nakatani et al reported that age, anemia, and eGFR were signi cantly and independently associated with HNA in pre-dialysis CKD patients 15 . Studies reported that hemodialysis may remove uremic toxins and ameliorate the redox status of albumin by decreasing levels of HNA 30,31 . In a community dwelling-based survey, the results demonstrated an inverse association between renal function and HNA 16 .…”

“…Collectively, these reports and the present ndings suggest that HNA is indeed signi cantly associated with the pro-atherosclerotic process.An elevated HNA level was reported to be pro-atherosclerotic in previous reports. Fujii et al investigated the associations between the redox status of serum albumin and the carotid intima-media thickness (IMT) in a total of 281 residents 30 . The results showed that a higher HNA level was positively correlated with a thicker carotid intima-media thickness (IMT) 32 .…”

Pilot study to investigate differences in middle molecules, oxidative stress and markers of peripheral vascular disease in patients treated by high flux haemodialysis and haemodiafiltration

“…Oxidative stress is reported to be increased in patients with CKD and HD patients [ 26 , 27 ]. As oxidative stress is associated with both increased cardiovascular and peripheral vascular disease [ 8 ], we measured ischaemia modified albumin and calculated the IMAR to allow comparison between patients.…”

“…Our results would support two earlier small observational studies. One in children, which reported lower oxidised low-density lipoprotein with HDF [ 26 ], and a second study based on 38 patients from Japan which reported that treatment with pre-dilution haemodiafiltration resulted in a higher mercapto-albumin to albumin ratio [ 27 ].However, not all studies have observed changes in oxidative stress, with one small study reporting varying results, with some lowering of total antioxidant capacity, but no change in superoxide dismutase [ 28 ]. Although slightly more HDF patients received were treated by thrice weekly schedules, haemodialysis treatments have themselves been reported to generate oxidative stress and generate peroxynitrite-induced oxidation of plasma lipids [ 29 ].…”

Non-mercaptalbumin is significantly associated with the coronary plaque burden and the severity of coronary artery disease

“…Nakatani et al reported that age, anemia, and eGFR were significantly and independently associated with HNA in pre-dialysis CKD patients 15 . Studies reported that hemodialysis may remove uremic toxins and ameliorate the redox status of albumin by decreasing levels of HNA 30 , 31 . Therefore, patients who received routine dialysis or had severe renal function were also excluded from the present study.…”