Online hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis
Claire H den Hoedt, Michiel L Bots, Muriel P C Grooteman, Neelke C van der Weerd, Albert H A Mazairac, E Lars Penne, Renée Levesque, Piet M ter Wee, Menso J Nubé, Peter J Blankestijn, Marinus A van den Dorpel, CONTRAST Investigators, M Dorval, R Lévesque, M G Koopman, C J A M Konings, W P Haanstra, M Kooistra, B van Jaarsveld, T Noordzij, G W Feith, H G Peltenburg, M van Buren, J J G Offerman, E K Hoogeveen, F de Heer, P J van de Ven, T K Kremer Hovinga, W A Bax, J O Groeneveld, A T J Lavrijssen, A M Schrander-Van der Meer, L J M Reichert, J Huussen, P L Rensma, Y Schrama, H W van Hamersvelt, W H Boer, W H van Kuijk, M G Vervloet, I M P M J Wauters, I Sekse, Claire H den Hoedt, Michiel L Bots, Muriel P C Grooteman, Neelke C van der Weerd, Albert H A Mazairac, E Lars Penne, Renée Levesque, Piet M ter Wee, Menso J Nubé, Peter J Blankestijn, Marinus A van den Dorpel, CONTRAST Investigators, M Dorval, R Lévesque, M G Koopman, C J A M Konings, W P Haanstra, M Kooistra, B van Jaarsveld, T Noordzij, G W Feith, H G Peltenburg, M van Buren, J J G Offerman, E K Hoogeveen, F de Heer, P J van de Ven, T K Kremer Hovinga, W A Bax, J O Groeneveld, A T J Lavrijssen, A M Schrander-Van der Meer, L J M Reichert, J Huussen, P L Rensma, Y Schrama, H W van Hamersvelt, W H Boer, W H van Kuijk, M G Vervloet, I M P M J Wauters, I Sekse
Abstract
Online hemodiafiltration may diminish inflammatory activity through amelioration of the uremic milieu. However, impurities in water quality might provoke inflammatory responses. We therefore compared the long-term effect of low-flux hemodialysis to hemodiafiltration on the systemic inflammatory activity in a randomized controlled trial. High-sensitivity C-reactive protein and interleukin-6 were measured for up to 3 years in 405 patients of the CONvective TRAnsport STudy, and albumin was measured at baseline and every 3 months in 714 patients during the entire follow-up. Differences in the rate of change over time of C-reactive protein, interleukin-6, and albumin were compared between the two treatment arms. C-reactive protein and interleukin-6 concentrations increased in patients treated with hemodialysis, and remained stable in patients treated with hemodiafiltration. There was a statistically significant difference in rate of change between the groups after adjustments for baseline variables (C-reactive protein difference 20%/year and interleukin-6 difference 16%/year). The difference was more pronounced in anuric patients. Serum albumin decreased significantly in both treatment arms, with no difference between the groups. Thus, long-term hemodiafiltration with ultrapure dialysate seems to reduce inflammatory activity over time compared to hemodialysis, but does not affect the rate of change in albumin.
Source: PubMed