Vitamins (A, C and E) and oxidative status of hemodialysis patients treated with HFR and HFR-Supra

Abstract

BackgroundHemodiafiltration with on-line endogenous reinfusion (HFR) is an extracorporeal dialytic method that combines diffusion, convection and adsorption. HFR-Supra (HFR-S) is a second-generation system with increased convective permeability and adsorption capability. Previous studies suggested that HFR reduces oxidative stress compared to standard haemodialysis. The principal aim of the present study was to compare antioxidant vitamins behavior and oxidative status of hemodialysis patients treated with HFR and HFR-S.MethodsThe study was designed as a multicenter, randomized, crossover trial. Forty-one patients were recruited from 19 dialysis centers and after a 4-month washout stabilization period in on-line hemodiafiltration (ol-HDF), each patient was randomized to a sequence of treatments (HFR-S followed by HFR or viceversa) with each treatment applied over 6 months. Plasma levels of Advanced Oxidation Protein Products, Total Antioxidant Status, vitamins C, A and E and their ligands (Retinol Binding Protein and total lipids) were measured at baseline and at the end of each treatment period.ResultsResults show that the higher convective permeability of HFR-S with respect to HFR did not produce additional beneficial effects on the patients’ oxidative status, a slight decrease of both Vitamin A and Retinol Binding Protein being the only difference registered in the long-term. However, as compared to ol-HDF, both the re-infusive techniques allowed to reduce the intradialytic loss of Vitamin C and, in the long-term, improve the patients’ oxidative status and increase Retinol Binding Protein plasma values. No significant differences were found between the Vitamin C concentration of pre- and post cartridge UF neither in HFR-S nor in HFR showing that the sorbent resin does not adsorb Vitamin C.ConclusionHFR-S and HFR are almost equivalent in term of impact on antioxidant vitamins and oxidative status of hemodialysis patients. Nonetheless, as compared to ol-HDF, both treatments produced a sensible sparing of Vitamin C and may represent a new approach for reducing oxidative stress and related complications in dialysis patients. Long-term effects of re-infusive treatments on patients’ cardiovascular morbidity and mortality need to be evaluated.Trial registrationClinicalTrials.gov Identifier NCT01492491, retrospectively registered in 10 December 2011.

Acute effect of one session of hemodiafiltration with endogenous reinfusion on uremic toxins and inflammatory mediators

“…Previous results have shown several clinical benefits for patients undergoing chronic HFR therapy, including extensive clearance of uremic toxins, reduced inflammatory conditions, decreased oxidative stress, relieved endothelial damage, as well as improved nutritional status and bone metabolism, 7,[11][12][13][14][15][16] thus finally improving several symptoms and complications due to uremia. 17 In this article, we focus on its acute effect when using a resin cartridge on uremic toxins and inflammatory mediators.…”

The Role of Oxidative Stress and Systemic Inflammation in Kidney Disease and Its Associated Cardiovascular Risk

“…In a meta-analysis by Susantitaphong [82], there was improvement in cardiac parameters, such as left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and blood pressure, in patients using frequent (2-8 h, > thrice weekly) or extended (>4 h, thrice weekly) haemodialysis, compared to a conventional (≤4 h, thrice weekly) haemodialysis schedule. Beyond utilization of ultrapure dialysate and highflux online haemodiafiltration, the addition of further convective permeability by utilizing hyper high flux membranes did not confer any extra benefits in oxidative stress markers [83].…”

Renal Replacement Modality Affects Uremic Toxins and Oxidative Stress

“…Oxidative stress may not only increase due to the bioincompatible catheters, membranes, and dialysis fluids in HD patients but also due to the low pH and high osmolarity of [28,36,37,58]. In addition, the loss of vitamins and/or trace elements during HD using high-permeable membranes may lead to disruption of the antioxidant system [59].…”