No Benefit of Hemodiafiltration over Hemodialysis in Lowering Elevated Levels of Asymmetric Dimethylarginine in ESRD Patients

Kalousová, Marta; Kielstein, Jan T.; Hodková, Magdaléna; Zima, Tomáš; Dusilová-Sulková, Sylvie; Martens‐Lobenhoffer, Jens; Bode‐Böger, Stefanie M.

doi:10.1159/000095360

Cited by 25 publications

(21 citation statements)

References 42 publications

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“…The findings of recent studies, showing no differences in ADMA elimination neither between hemodiafiltration and low-flux HD 17,18 nor among different membrane dialyzers, 18 suggest that plasma proteins that bind ADMA are larger than 40 kDa. 7 Whether ADMA levels reduced in the long-term treatment or modalities with increased convective transport remain to be established.…”

Section: Discussionmentioning

confidence: 94%

Differences in Bio-incompatibility among Four Biocompatible Dialyzer Membranes Using in Maintenance Hemodialysis Patients

et al. 2011

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Background: Following the introduction of modified cellulosic and then synthetic membrane dialyzers, it was realized that the dialyzer bio-incompatibility depends on the membrane composition. We designed a prospective, randomized, cohort study of 6 months to determine several parameters of biocompatibility in maintenance hemodialysis (MHD) patients treated with four different membrane dialyzers. Methods: There were 60 MHD patients enrolled in the study. In baseline, synthetic low-flux dialyzer, polysulfone (PS) membrane was used in all patients for at least 3 months. Then the patients were randomly divided into three groups according to different dialyzer membranes. Synthetic highflux dialyzer group, ployethersulfone membrane, cellulose triacetate (CTA) high-flux membrane, and synthetic low-flux dialyzer, polymethylmethacrylate (PMMA) membrane were used in 6 months. A new dialyzer was used for each study treatment, and there was no dialyzer reuse. The biocompatibility markers and solutes removal markers were detected repeatedly at different time points. Results: The blood levels of highly sensitive C reactive protein, interleukin (IL)-1β, and interleukin (IL)-13 showed no difference among different groups at al time points. However, the blood complement levels and white blood cell counts were significantly different among three groups. When the dialyzers changed from PS to PMMA membrane, C3a levels and white blood cell counts changed significantly (p < 0.05). Moreover, the changes of C5a levels were significantly different between group CTA and group PMMA in month 3 (p < 0.05). Conclusion: There were much more differences on bio-incompatibility among different dialyzer membranes.

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Section: Discussionmentioning

confidence: 94%

Differences in Bio-incompatibility among Four Biocompatible Dialyzer Membranes Using in Maintenance Hemodialysis Patients

et al. 2011

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“…A variety of other investigators analyzed plasma ADMA levels in HD patients [27,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. Since the results are almost identical to those studies that included a control group we did not summarize these studies in a separate table.…”

Section: Resultsmentioning

confidence: 99%

“…We identified 19 studies in which the impact of a single HD session on the clearance of ADMA was analyzed [1, 8, 13,27,28,29,30,31,33,34,35,39,40,41,42,43, 59, 62, 63]. The studies included 245 patients; in 10 studies reduction of SDMA levels was also analyzed.…”

Section: Resultsmentioning

confidence: 99%

Asymmetrical Dimethylarginine in Renal Disease: Limits of Variation or Variation Limits?

Jacobi

Tsao

2007

Am J Nephrol

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Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is increasingly recognized as a putative biomarker in cardiovascular and renal disease. Elevated plasma levels of ADMA are the consequence of increased synthesis, reduced renal clearance or reduced enzymatic degradation. Based upon the metabolic fate the highest plasma concentrations of ADMA have been reported in patients with renal failure in whom this molecule accumulates. However, the range of published ADMA levels in patients with chronic renal failure as well as in patients with end-stage renal failure undergoing maintenance hemodialysis, peritoneal dialysis or kidney transplant recipients is widely scattered and overlaps with the levels reported in healthy individuals. This wide distribution can in part be explained by different bioanalytical techniques and the lack of standardization of such assays. This review summarizes available literature on ADMA in patients with kidney disease and stresses the urgent need for a consensus regarding reference values for different analytical methods in order to appreciate the prognostic significance of elevated ADMA levels. At present, one cannot advocate this molecule for risk assessment or individual patient prognosis in the clinical work-up of patients with renal impairment.

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“…This finding was shown with hemodiafiltration over hemodialysis for middle molecules and small watersoluble molecules such as urea. 27,32,56,107 Methodological choices, in terms of quantification techniques, could also influence reported concentrations. A cross-sectional comparison of HPLC, MS, and ELISA determinations of ADMA showed large variability across and within techniques, and it found that MS was the most reliable measurement method.…”

Section: Variability In Concentrationsmentioning

confidence: 99%

Normal and Pathologic Concentrations of Uremic Toxins

Duranton¹,

Cohen

Smet

et al. 2012

Journal of the American Society of Nephrology

827

764

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An updated review of the existing knowledge regarding uremic toxins facilitates the design of experimental studies. We performed a literature search and found 621 articles about uremic toxicity published after a 2003 review of this topic. Eighty-seven records provided serum or blood measurements of one or more solutes in patients with CKD. These records described 32 previously known uremic toxins and 56 newly reported solutes. The articles most frequently reported concentrations of b2-microglobulin, indoxyl sulfate, homocysteine, uric acid, and parathyroid hormone. We found most solutes (59%) in only one report. Compared with previous results, more recent articles reported higher uremic concentrations of many solutes, including carboxymethyllysine, cystatin C, and parathyroid hormone. However, five solutes had uremic concentrations less than 10% of the originally reported values. Furthermore, the uremic concentrations of four solutes did not exceed their respective normal concentrations, although they had been previously described as uremic retention solutes. In summary, this review extends the classification of uremic retention solutes and their normal and uremic concentrations, and it should aid the design of experiments to study the biologic effects of these solutes in CKD. The uremic syndrome is characterized by the retention of various solutes that would normally be excreted by the kidneys. The substances that interact negatively with biologic functions are called uremic toxins. In the past years, research on uremic toxicity has been very dynamic and resulted in the identification of dozens of retention solutes, including several uremic toxins. In 2003, the European Uremic Toxin Work Group (http://www.uremic-toxins.org/) proposed a classification of 90 retention solutes providing data on normal and pathologic serum concentrations. 1 In 2007, results were further discussed and expanded with the addition of 14 solutes. 2,3 This collaborative work focused on the highest mean or median concentration of the solutes measured in a uremic population and the highest individual uremic concentration. These data were particularly relevant for researchers on uremic toxicity, and they became a successful tool for allowing use of standardized and biologically relevant concentrations in experimental settings. More recently, scientific and technological progress resulted in the identification of many new uremic retention solutes, particularly thanks to nontargeted approaches such as metabolomic and proteomic profiling. 4,5 To maintain experimental guidelines in keeping with current knowledge, it seemed necessary to propose an update of the encyclopedic review.

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No Benefit of Hemodiafiltration over Hemodialysis in Lowering Elevated Levels of Asymmetric Dimethylarginine in ESRD Patients

Cited by 25 publications

References 42 publications

Differences in Bio-incompatibility among Four Biocompatible Dialyzer Membranes Using in Maintenance Hemodialysis Patients

Differences in Bio-incompatibility among Four Biocompatible Dialyzer Membranes Using in Maintenance Hemodialysis Patients

Asymmetrical Dimethylarginine in Renal Disease: Limits of Variation or Variation Limits?

Normal and Pathologic Concentrations of Uremic Toxins

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