Haemodiafiltration elicits less platelet activation compared to haemodialysis

Abstract

BackgroundMortality in patients with end-stage renal disorders is often a consequence of cardiovascular complications. Renal replacement therapies may contribute to this morbidity by promoting cellular activation. In renal failure patients peripheral blood samples were investigated for platelet and endothelial cell activation markers to compare the effects of haemodiafiltration (HDF) and haemodialysis (HD).MethodsOverall 28 patients were included in the study. Platelet P-selectin and leukocyte - platelet heterotypic aggregates were studied by flow cytometry. Soluble P- and E-selectin values were determined by ELISA, while von Willebrand factor (vWF) antigen levels were measured by immunoturbidimetry. Statistical analysis was done by the SPSS v22 software.ResultsPlatelet surface P-selectin was below 3.0 % in healthy controls, but it was higher during the dialysis after 4 h, 8 % and 14.3 % in HDF and HD, respectively. Monocyte-platelet heterotypic aggregates were significantly elevated after 4 h in both treatments, up to 69.2 % in HDF and to 82.9 % in HD. Soluble P-selectin levels were also significantly elevated by the end of both treatment procedures (p < 0.001), vWF antigen values, however, showed elevation only during HD treatment.ConclusionsThe attenuated platelet activating effects of HDF compared to HD may contribute to a less unfavourable vascular effect in this treatment modality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0364-x) contains supplementary material, which is available to authorized users.

The effect of high‐flux hemodialysis and post‐dilution hemodiafiltration on platelet closure time in patients with end stage renal disease

“…There was no increase in microparticles, PF4, or thrombin antithrombin complexes (TATs) . In recent reports, the biocompatibility of the dialyzer membranes was monitored by the platelet count and it was concluded that the more biocompatible newer membranes, like the polysulfones, do not result in marked thrombocytopenia . In our study, platelet count after the procedure was lower in the case of HD, as well as in the case of HDF, but the difference was statistically significant only in the case of HDF, although in both cases high‐flux dialyzers were used.…”

“…Convective transport in HDF can dramatically increase the excretion of small to mid‐size proteins and it also increases the excretion of smaller molecules in comparison to HD. However, it is not clear whether the decreased platelet activation can be explained by the increased elimination of the enhancers of platelet activation during HDF concluded Becs et al The results of this study are contrary to our study, as prolonged platelet closure time after HDF could indirectly reflect enhanced platelet activation during the procedure.…”

“…Hemodiafiltration (HDF) is a technique with high convective transport that was developed to increase the clearance of substances with middle molecular weight, and which may also reduce the degree of platelet activation and improve platelet reactivity …”

“…1 Hemodiafiltration (HDF) is a technique with high convective transport that was developed to increase the clearance of substances with middle molecular weight, and which may also reduce the degree of platelet activation and improve platelet reactivity. 1,2 In post-dilution HDF, the replacement fluid is infused downstream of the dialyzer, usually into the venous bubble trap. 3 Observational data have suggested that HDF is beneficial.…”

Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

“…33 As complement activation can increase microparticle production and clotting, 27 then, this could potentially have led to differences between the two different dialyzers. One previous study has suggested less platelet activation with hemodialfiltration compared to standard hemodialysis, 34 and our study would suggest that dialyzer membranes, made from ATA and PS and PVP, designed for high volume online hemodiafiltration, allow the achievement of high volume exchanges without an increased risk of extracorporeal circuit clotting. One previous study has suggested less platelet activation with hemodialfiltration compared to standard hemodialysis, 34 and our study would suggest that dialyzer membranes, made from ATA and PS and PVP, designed for high volume online hemodiafiltration, allow the achievement of high volume exchanges without an increased risk of extracorporeal circuit clotting.…”