Effects of Hemodiafiltration on Uremic Inflammation

Abstract

Chronic inflammation is highly prevalent among end-stage renal disease patients and is linked to, and thought to contribute to, the high morbidity and mortality in this patient population. Hemodiafiltration (HDF) may potentially reduce inflammatory stimuli induced by the bioincompatibility of conventional hemodialysis (HD) systems. In addition, HDF may more efficiently remove inflammatory mediators. This brief review shows that the circulating levels of various markers of systemic inflammation in general are somewhat reduced in patients treated by HDF as compared to HD. On the other hand, according to the current literature, this favorable small impact on inflammation biomarkers does not seem to translate into better clinical outcomes. It is possible that this is due to inadequate design, inadequate number of investigated patients and too short duration of previous studies. The results of larger, better-designed ongoing prospective studies may hopefully clarify this.

Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children

“…A second important advantage of HDF is the enhanced removal of middle molecules by convection [ 9 , 23 ]. Substances that have molecular weights lower than albumin can be removed by convection, but this is strongly influenced by the mass transfer coefficient of the dialysis membrane [ 24 ] and the convective volume applied [ 25 ].…”

“…Hemodiafiltration (HDF) is a newer technique of dialysis that achieves clearance of middle and large molecular weight solutes unlike conventional hemodialysis (HD). HD is based on the diffusive transport of solutes across a semipermeable membrane and is effective in removing small solutes only, whereas HDF also involves the infusion of sterile, pyrogen-free fluid either pre- or post-filter and thereby allows clearance by convection as well as diffusion [ 9 , 10 ]. Analysis of pooled individual participant data from randomized controlled trials has shown survival benefits of high volume-HDF on all-cause mortality and especially cardiovascular mortality rate [ 11 – 13 ].…”

“…The mechanisms that lead to improved outcomes are not clear, but it is thought that HDF may reduce the production of inflammatory mediators through the use of biocompatible dialysers and ultra-pure dialysate and also improve clearance of larger molecular weight substances, many of which are associated with oxidative stress, inflammation and endothelial dysfunction [ 14 , 15 ]. However it is not clear if this improved removal of inflammatory mediators translates into better clinical outcomes [ 9 ].…”

Effect of high volume hemodiafiltration on secondary hyperparathyroidism among hemodialysis patients

“…HD is based on the diffusive transport of solutes across a semipermeable membrane and is effective in removing small solutes only, whereas HDF also involves the infusion of sterile, pyrogen-free fluid either pre-or post-filter and thereby allows clearance by convection as well as diffusion. 7 Our study was conducted on 95 chronic hemodialysis patients on regular hemodialysis (HD). They were divided into four groups: Group A included 60 patients scheduled 6 months conventional high flux (hf-HD) (Period 1) immediately followed by 6 months of post-dilutional -HDF (Period 2).…”

Principles and Practices of Haemodiafiltration

“…Inflammation in chronic kidney disease has been associated with a range of negative outcomes, including cardiovascular mortality [44], atherosclerosis, protein energy wasting, hyporesponsiveness to erythropoiesis stimulating agents (ESAs), platelet dysfunction and endocrine dysfunction [45]. Chronic inflammation is caused by both cytokine dysregulation in chronic kidney disease [46], and the dialysis process itself [47].…”