Short-term effects of hemodiafiltration versus conventional hemodialysis on erythrocyte performance

Abstract

Hemodiafiltration (HDF) is a renal replacement therapy that is based on the principles of diffusion and convection for the elimination of uremic toxins. A significant and increasing number of end-stage renal disease (ESRD) patients are treated with HDF, even in the absence of definite and conclusive survival and anemia treatment data. However, its effects on red blood cell (RBC) physiological features have not been examined in depth. In this study, ESRD patients under regular HDF or conventional hemodialysis (cHD) treatment were examined for RBC-related parameters, including anemia, hemolysis, cell shape, redox status, removal signaling, membrane protein composition, and microvesiculation, in repeated paired measurements accomplished before and right after each dialysis session. The HDF group was characterized by better redox potential and suppressed exovesiculation of blood cells compared with the cHD group pre-dialysis. However, HDF was associated with a temporary but acute, oxidative-stress-driven increase in hemolysis, RBC removal signaling, and stomatocytosis, probably associated with the effective clearance of dialyzable natural antioxidant components, including uric acid, from the uremic plasma. The nature of these adverse short-term effects of HDF on post-dialysis plasma and RBCs strongly suggests the use of a parallel antioxidant therapy during the HDF session.

The Multi-Faced Extracellular Vesicles in the Plasma of Chronic Kidney Disease Patients

“…The same inducers modify the EV phenotypes and micro-RNA (miRNA) cargos, often in cell-specific (Faure et al, 2006;Trappenburg et al, 2012), or dialysis modal-specific ways (Cavallari et al, 2019). For instance, MV concentration is lower in patients treated by hemodiafiltration versus conventional hemodialysis (Georgatzakou et al, 2018). By examining the short-term effects of a single dialysis session on EV measurements, dialysis still triggers release of MVs but again, with marked differences between high-flux and low-flux dialyzers (de Laval et al, 2019).…”

“…By examining the short-term effects of a single dialysis session on EV measurements, dialysis still triggers release of MVs but again, with marked differences between high-flux and low-flux dialyzers (de Laval et al, 2019). As to the accumulation of the PS-exposing MVs (Georgatzakou et al, 2018) and smaller EVs (Ruzicka et al, 2019), dialysis generally exerts a beneficial acute effect, mediated in part by EV absorbance to the dialysis membrane (Ruzicka et al, 2019), at least in patients with adequate response to EpO (Georgatzakou et al, 2017). Additionally, hemodialysis seems to be more effective in eliminating small compared to bigger EVs (Ruzicka et al, 2019).…”

Neutrophil Elastase Inhibitors and Chronic Kidney Disease

“…Hemodiafiltration showed an improvement in redox potential and no exovesiculation of blood cells, compared to conventional hemodialysis, although the adverse short-term temporary but acute, oxidative-stress-driven increase in hemolysis suggest the use of antioxidant treatment during hemodiafiltration 164 . The RBCs in ESRD RhEPO responders, compared to non-responders (with enhanced inflammation), showed a predisposition to hemolysis under mechanical stress, more susceptibility to erythrophagocytosis favored by the excess of membrane-bound IgGs, a severe deficiency in CD47 protein in the membrane, and a lower expression of peroxiredoxin 2 induced by oxidative stress 165 - 167 .…”

Blood Cell Proteomics in Chronic Kidney Disease

“…The results of a recent study indicate that also the type of extracorporeal renal replacement therapy might play a role on the physiological features of ESRD RBCs [56]. The authors compared a number of RBC-related parameters in ESRD patients undergoing HD (a technique based mainly on the principle of diffusion) or hemodiafiltration (a technique based on both diffusion and convection).…”

“…While hemodiafiltration was associated with a better redox potential and a suppression of RBC exovesiculation before dialysis, it was also characterized by an acute, temporary, oxidative stress-driven increase in RBC removal signaling and hemolysis. This abnormality may be attributed to the removal of dialyzable antioxidant compounds from the uremic plasma and suggests the use of antioxidant therapy during the hemodiafiltration session [56], a concept that requires further investigation.…”