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Background: Vitamin D [25(OH)D] deficiency is a cardiovascular risk factor in the hemodialysis (HD) population. The aim of this study was to identify hypovitaminosis D in HD patients without signs of hyperparathyroidism and to analyze its association to inflammation and echocardiographic alterations. Methods: Patients on HD with iPTH <300 pg/ml not receiving vitamin D therapy were recruited. Hypovitaminosis D was defined as 25(OH)D <30 ng/ml. High-sensitivity C-reactive protein, interleukin-6 and serum albumin were used as inflammation markers. Echocardiograms were performed in an interdialytic mid-week day. Results: Sixty-one patients (mean age of 56 ± 15 years, 52% males, 93% Caucasians, 31% diabetic) were included, and 75% presented hypovitaminosis D. Inflammation was more prevalent among those with hypovitaminosis D, and these patients presented higher relative wall thickness (0.48 ± 0.11 vs. 0.42 ± 0.10 mm; p = 0.05) and lower left ventricular diastolic (49.8 ± 6.2 vs. 54.7 ± 5.8 mm; p = 0.013) and systolic (31.9 ± 5.7 vs. 36.8 ± 7.2 mm; p = 0.012) diameters. Conclusions: Hypovitaminosis D is associated with inflammation and concentric geometric pattern of the left ventricle, even in the absence of high iPTH levels. Vitamin D repletion (aiming to reduce cardiovascular complications) should also be considered in HD patients with normal or low iPTH levels.

Background and objectives High‐volume online hemodiafiltration (OL‐HDF) associates with improved outcomes compared to hemodialysis (HD), provided adequate dosing is achieved as estimated from convective volume (CV). Achievement of high CV and its impact on biochemical indicators following a standardized protocol converting HD patients to OL‐HDF has not been systematically reported. We assessed the success of implementation of OL‐HDF in clinics naïve to the modality. Design, setting, participants, and measurements We analyzed the results of the implementation of postdilution OL‐HDF in patients randomized to the HDF arm of a clinical trial (impact of hemoDiaFIlTration on physical activity and self‐reported outcomes: a randomized controlled trial (HDFit) trial [http://clinicaltrials.gov:NCT02787161]). The day before randomization of the first patient to OL‐HDF at each clinic staff started a 3‐day in‐person training module on operation of Fresenius 5008 CorDiax machine in HDF mode. Patients were converted from high‐flux HD to OL‐HDF under oversight of trainers. OL‐HDF was performed over a 6‐months follow‐up with a CV target of 22 L/treatment. We characterized median achieved CV >22 L/treatment record and analyzed the impact of HDF on biochemical variables. Results Ninety‐seven patients (mean age 53 ± 16 years, 29% with diabetes, and 11% had a catheter) from 13 clinics randomized to the OL‐HDF arm of the trial were converted from HD to HDF. Median CV > 22 L/treatment was achieved in 99% (94/95) of OL‐HDF patients throughout follow‐up. Monthly mean CV ranged from 27.1 L to 27.5 L. OL‐HDF provided an increased single pool Kt/V at 3‐months (0.2 [95% CI: 0.1–0.3]) and 6‐months (0.2 [95% CI: 0.1–0.4]) compared to baseline, and reduced phosphate at 3‐months (−0.4 mg/dL [95% CI: −0.8 to −0.12]) of follow‐up. Conclusions High‐volume online hemodiafiltration was successfully implemented with 99% of patients achieving protocol defined CV target. Monthly mean CV was consistently >22 L/treatment during follow‐up. Kt/V increased, and phosphate decreased with OL‐HDF. Findings resulting from a short training period in several dialysis facilities appear to suggest HDF is an easily implementable technique.

Background Patients with chronic kidney disease (CKD) have a severe vitamin D deficiency and increasing epidemiological data suggesting that this deficiency may play a role in overall morbidity and mortality associated with CKD. It is known that vitamin D regulates the immune system, however, in dialysis patients this deficiency and the modulation of proinflammatory cells is unclear. Among these, monocytes arouse interest considering they constitutively express vitamin D receptors. Aim This study aimed the evaluation of monocytic profile in CKD patients according to vitamin D levels. Methods Patients in hemodialysis (HD) were divided into two groups, regarding vitamin D levels: Group 1, vitamin D <26 ng/ml (n = 15) and Group 2, vitamin D ≥26 ng/ml (n = 18). Whole blood was collected aiming evaluation of (a) monocytic populations through CD14 and CD16 expression, (b) reactive oxygen species (ROS) generation, and (c) apoptosis. Results We observed that in Group 1, when compared to Group 2, there was a significant increase in intermediate monocytes (CD14++CD16 +; 34.7 ± 31.6 vs. 12.1 ± 6.3; p = 0.006, respectively) and decrease in classical ones (CD14 ++CD16 −; 45.3 ± 31.8 vs. 70.4 ± 25.1; p = 0.017, respectively). There was no difference between groups regarding nonclassical monocytes (CD14 +CD16 ++), as well as to apoptosis and to ROS generation. Conclusion This study suggests that HD patients with lower vitamin D levels might have an intensified inflammatory outline as intermediate monocytes with an inflammatory pattern are increased in this population, when compared with patients with higher levels of vitamin D.

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