Role of Vitamin E-Coated Membrane in Reducing Advanced Glycation End Products in Hemodialysis Patients: A Pilot Study

Abstract

Introduction: Advanced glycation end products (AGEs) are markers of oxidative stress. Aims: To assess if a vitamin-E-coated dialyzer affects plasma AGE levels and endothelial function in hemodialysis patients. Methods: 16 patients were dialyzed with a synthetic modified cellulose membrane (SMC, n = 8) or a vitamin E-coated dialyzer (n = 8), respectively. At week 32 endothelial function was determined as brachial artery flow-mediated dilatation (FMD). Total AGEs, free pentosidine (FP), protein-bound pentosidine (BP) and autoantibodies against oxidized LDL (ox-LDL-autoantibodies) were assessed at baseline (T0) and at 16, 32, 40 and 42 weeks (T16, T32, T40 and T42). Results: At T16 and T32 FP and BP were lower in vitamin E than in SMC (T 16: 88.7 ± 8.96 vs. 124.2 ± 11.90 pmol/ml plasma; p = 0.04, and 22.9 ± 2.99 vs. 32.8 ± 2.98 pmol/mg proteins; p = 0.04. T32: 78.7 ± 8.54 vs. 123.7 ± 10.15 pmol/ml plasma; p = 0.007, and 19.9 ± 2.0 vs. 33.67 ± 2.41 pmol/mg proteins; p = 0.001). In vitamin E, AGEs were lower at T32, T40 and T42 (946.7 ± 80.91 vs. 1,351.2 ± 179.33 AU/ml, p = 0.05; 986.9 ± 59.63 vs. 1,509.9 ± 154.17 AU/ml, p = 0.013; 890.3 ± 73.70 vs. 1,453.9 ± 153.16 AU/ml, p = 0.009). At T32 AGEs, ox-LDL autoantibodies and FMD were inversely correlated (R = –0.70 p = 0.007 and R = –0.59, p = 0.04, respectively). Conclusions: Vit E-coated membrane reduces plasma AGEs levels and AGEs values are negatively correlated with FMD.

Effects of vitamin E-coated dialysis membranes on anemia, nutrition and dyslipidemia status in hemodialysis patients: a meta-analysis

“…The effect of vitamin E-coated dialyzer on HB level was assessed in six trials, 8,14,15,21,23,25 this meta-analysis showed a nonsignificant increase in HB level compared with that of control (MD, À0.03; 95% CI, À0.18 to 0.13; p ¼ 0.74; Figure 3), with significant heterogeneity between studies (p ¼ 0.06; I 2 ¼ 50%). Six studies reported the EPO dose as mean and standard deviation, 8,[13][14][15]23,25 the fixed model was performed for meta-analysis.…”

“…Among them, duplicate records, non-RCTs or quasi-RCTs, review and letter, article not in English, other intervention and concerning other outcome were excluded. After the progressive selection process, 14 eligibility studies 1,8,[13][14][15][16][21][22][23][24][25][26][27][28] including five crossover and nine parallel-arm trials were included in this meta-analysis ( Figure 1). …”

“…Of these 14 included studies, seven of the 14 included studies compared vitamin E-coated dialyzer with polysulfone dialyzer 8,[14][15][16]22,25,28 while four studies compared with cellulose membrane dialyzer. 1,13,21,26 Mean age of study participants ranged from 51.9 to 72.3 years, with follow-up ranged from 1 to 12 months.…”

“…14,21,23,24 When the metaanalysis was performed, no significant effect was found after conversion from conventional dialyzer to vitamin E-coated dialyzer (SMD, À0.64; 95% CI, À1.62 to 0.34; p ¼ 0.2), with evidence of heterogeneity (p ¼ 0.004; I 2 ¼ 78%).…”

Review of the Effectiveness of Cellulose- and Polysulfone-Based Vitamin E-Bonded Dialysis Membranes

“…A larger multicenter study (172 patients) reported by Cruz et al, 2008, confirmed that the impact of Excebrane dialyzers on anemia parameters was better than that of other high-flux biocompatible dialyzer membranes, including cellulose acetate, polysulfone, and polymethylmethacrylate. Other reports demonstrated positive effects such as (1) decreased oxidative stress (Tarng et al, 2000;Miyazaki et al, 2000;Clermont et al, 2001;Westhuyzen et al, 2003;Bufano et al, 2004;Mydlik et al, 2004;Calò et al, 2004;Yang et al, 2006;and Odetti et al, 2006), (2) suppression of leukocyte activation (Omata et al, 2000;Zaluska et al, 2001;Pertosa et al, 2002;Tsuruoka et al, 2002;Libetta et al, 2004;and Kojima et al, 2005), (3) dosage reduction of anticoagulants (Huraib et al, 2000), (4) improved biocompatibility (Yoshida et al, 2002), and (5) decreased levels of advanced glycation end products (AGEs) (Baragetti et al, 2006). Moreover, a recent study reported by Kirmizis D et al, 2010, showed that the levels of inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and soluble intercellular adhesion molecule (sICAM)-1 in 35 patients treated with Excebrane were lower than those in the baseline evaluation carried out with conventional low-or middle-flux dialyzers.…”