Evaluation of the Impact of a New Synthetic Vitamin E-Bonded Membrane on the Hypo-Responsiveness to the Erythropoietin Therapy in Hemodialysis Patients: A Multicenter Study

Abstract

Background: Oxidative stress has been related to hypo-response to erythropoiesis-stimulating agents (ESAs) in hemodialysis (HD) patients. The aim of this study was to verify whether vitamin E (ViE) on a synthetic polysulfone dialyzer can improve ESA responsiveness. Methods: This controlled, multicenter study involved 93 HD patients on stable ESA therapy, who were randomized to either ViE-coated polysulfone dialyzer or to a low-flux synthetic dialyzer. The primary outcome measure was the change in ESA resistance index (ERI) from baseline. Results: Mean ERI decreased in the ViE group by 1.45 IU/kg*g/dl and increased in the control group by 0.53 IU/kg*g/dl, with a mean difference of 1.98 IU/kg*g/dl (p = 0.001 after adjusting for baseline ERI, as foreseen by the study protocol). Baseline ERI was inversely related to its changes during follow-up only in the control group (R² = 0.29). Conclusions: The ViE dialyzer can improve ESA response in HD patients. Changes in ERI during follow-up are independent from baseline ERI only in the ViE group. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=453442.

The influence of vitamin E-coated dialysis membrane on oxidative stress during a single session of on-line hemodiafiltration

“…Significantly lower concentration of oxidative stress parameters is achieved on-line by hemodiafiltration with a vitamin E coated membrane in continuity over a 3-6 months period relative to standard hemodialysis with a low-flux membrane without vitamin E. The results of clinical trials suggest that healing with on-line hemodiafiltration, with "highflux" membranes over a period of 3-6 months, significantly reduces inflammation, oxidative stress and resistance to erythropoietin activity, compared to hemodialysis with "low-flux" membranes [17,18]. Hemodialysis membranes (vitamin E-coated hemodialysis) have also shown the reduction of lipid peroxidation parameters values in the serum, such as: malondialdehyde (MDA), thiobarbituric acid reactive substances (TBARS) and oxidized LDL cholesterol (oxLDL) [19][20][21][22][23][24]. Some studies highlighted that these membranes also reduce the concentration of oxidative nucleic acid parameters such as 8-OHdG (8-hydroxydeoxyguanosine) and the concentration of microinflammatory parameters (CRP, interleukin-6) [19][20][21][22][23][24].…”

“…Hemodialysis membranes (vitamin E-coated hemodialysis) have also shown the reduction of lipid peroxidation parameters values in the serum, such as: malondialdehyde (MDA), thiobarbituric acid reactive substances (TBARS) and oxidized LDL cholesterol (oxLDL) [19][20][21][22][23][24]. Some studies highlighted that these membranes also reduce the concentration of oxidative nucleic acid parameters such as 8-OHdG (8-hydroxydeoxyguanosine) and the concentration of microinflammatory parameters (CRP, interleukin-6) [19][20][21][22][23][24]. Treatment with high-flux hemodialysis with polysulphonic membrane-bound vitamin E over a period of three to six months significantly reduces oxidative stress, microinflammation, erythropoietin resistance index, corrects the treatment of anemia, reduces the amount of erythropoietin and the thickness of intima-media of carotid arteries in population of patients treated with regular hemodialysis without affecting hemodialysis adequacy parameters (Kt/V index) [19][20][21][22][23][24].…”

“…Some studies highlighted that these membranes also reduce the concentration of oxidative nucleic acid parameters such as 8-OHdG (8-hydroxydeoxyguanosine) and the concentration of microinflammatory parameters (CRP, interleukin-6) [19][20][21][22][23][24]. Treatment with high-flux hemodialysis with polysulphonic membrane-bound vitamin E over a period of three to six months significantly reduces oxidative stress, microinflammation, erythropoietin resistance index, corrects the treatment of anemia, reduces the amount of erythropoietin and the thickness of intima-media of carotid arteries in population of patients treated with regular hemodialysis without affecting hemodialysis adequacy parameters (Kt/V index) [19][20][21][22][23][24]. The results of the conducted study show that after a single session of the on-line hemodiafiltration with "high-flux" polysulfone membrane coated with vitamin E (Leocced 21H), the concentration of thiobarbituric acid reactive substances (TBARS) and the superoxide dismutase activity is significantly reduced.…”

A Retrospective Study on Erythropoiesis Stimulating Agent Dose Reducing Potential of an Anti‐Platelet Activation Membrane Dialyzer in Hemodialysis Patients

“…The authors further pointed out that the baseline ERI levels were higher in the studies describing ESA‐sparing effects of vitamin‐E‐coated membranes than in those showing no such effects . This notion holds true for a recent multicenter trial of a vitamin‐E‐coated membrane that reports an ESA‐sparing effect of the membrane in hemodialysis patients with median ERI of 12.8 . It appears that the ESA‐sparing potentials of the vitamin‐E‐coated membrane and the NV dialyzer are independent of their effects on systemic inflammation.…”

Choosing a dialyzer: What clinicians need to know

“…Vitamin E coated dialyzers potentially may have an antioxidative effect, and small studies have suggested greater response to erythropoietins . However, these preliminary reports have not been substantiated to show more robust and sustained benefits.…”