The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study

Molina, Pablo; Vizcaíno, Belén; Molina, Mariola D; Beltrán, Sandra; González-Moya, Mercedes; Mora, Antonio M.; Castro-Alonso, Cristina; Kanter, Julia; Ávila, Ana; Górriz, José Luis; Estáñ, Nuria; Pallardó, Luís; Fouque, Denis; Carrero, Juan Jesús

doi:10.1093/ndt/gfx342

Cited by 60 publications

(44 citation statements)

References 51 publications

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“…subclinical chronic inflammation, which is not irrelevant, these values being still associated with increased mortality risk [12,17]. The effect on the inflammatory biomarkers may be due to higher convection volume achieved with MID leading to enhanced convective clearance of middle molecules [18,31]. According to the "reverse" configuration of the dialyzer [25], we can postulate that the amount of convection volume in post-dilution mode achieved in MID is closer to therapeutic goals currently recommended (> 23 L/session) [7][8][9][10], and are greater than that obtained by means of HDF in post-dilution mode.…”

Section: Discussionmentioning

confidence: 99%

“…The survival benefit may at least in part depend on the modulation of chronic inflammation [11][12][13][14][15][16][17], and the associated improvement of nutritional status [18], consequent to increased convective volume. Indeed, Canaud et al [17] reported that C-Reactive Protein (CRP) decreases at higher convection, up to at least 25 L per session, even after adjustment for main confounders.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, Canaud et al [17] reported that C-Reactive Protein (CRP) decreases at higher convection, up to at least 25 L per session, even after adjustment for main confounders. More recently, high convection dose has been reported to improve Protein-Energy Wasting markers in HD patients, thus preserving lean body mass [18].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients

et al. 2018

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Mid-dilution hemodiafiltration (MID) is a dialytic technique that might improve systemic inflammation of patients in chronic hemodialysis (HD) by increasing substitution volumes. To verify this hypothesis, we performed a prospective cross-over study comparing the effect on inflammatory biomarkers of higher convection by MID versus standard convection by post-dilution hemodiafiltration (HDF). Patients under chronic HD were therefore treated by MID and HDF by crossover design. Each treatment period lasted 4 months, with 1 month of wash-out where patients were treated by HD, for a total of 9 months. Primary outcome was the change of serum pre-dialytic C-Reactive Protein (CRP), interleukin 6 (IL-6), IL-1, IL-10, transforming growth factor-β (TGF-β), tumor necrosis factor-α, albumin and pre-albumin. Samples were obtained monthly. Ten HD patients were enrolled (age: 64.9 ± 12.6 years; 70% males; dialytic vintage: 10.6 [2.7–16.2] years). Mean convection volume was 40.1 ± 2.5 L/session in MID and 20.1 ± 2.6 L/session in HDF. A significant reduction of β2-Microglobulin was detected as a result of either treatment. In MID, CRP decreased from 11.3 (3.2–31.0) to 3.1 (1.4–14.4) mg/L (p = 0.007), IL-6 from 12.7 (5.0–29.7) to 8.3 (4.4–14.0) pg/mL (p = 0.003), and TGF-β from 10.6 (7.4–15.6) to 7.4 (5.9–9.3) ng/mL (p = 0.001). A significant reduction of CRP from 8.5 (3.2–31.0) to 4.6 (3.2–31.0) mg/L was also detected in HDF (p = 0.037), whereas no significant reduction of IL-6 (p = 0.147) and TGF-β (p = 0.094) was found. Percentage reduction of IL-6 correlated with mean convective volume in HDF (R = 0.666; p = 0.036) and in MID (R = 0.760; p = 0.020). Therefore, MID and HDF are associated with an attenuation of inflammatory pattern that is correlated with a high convective volume.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients

et al. 2018

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“…Furthermore, high convection and substitution volumes can be reached safely with on-line HDF (OL-HDF), and OL-HDF is able to markedly enhance the removal of middle molecular substances. There are reports of several clinical advantages of OL-HDF, including the reduction of intra-dialytic hypotension [1], improvement of inflammation and oxidative stress [2], maintenance of better nutritional conditions [3], and improved survival [4][5][6]. Performance of OL-HDF with substitution fluid reinfusion in predilution or postdilution mode is a common clinical practice in HD centers.…”

Section: Introductionmentioning

confidence: 99%

Predilution On-Line Hemodiafiltration Improves Albumin Redox in Maintenance Hemodialysis Patients

et al. 2019

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Background/Aim: In this study, we compared the dialysis efficiency, oxidative stress, and nutritional conditions between predilution on-line hemodiafiltration (pre-OL-HDF) and conventional hemodialysis (HD) using a super-flux dialyzer (CHD). Method: This was a crossover study of 38 maintenance HD patients. All patients were treated with CHD for the first 4 months (1st CHD period), then were switched to pre-OL-HDF for 4 months (pre-OL-HDF period), and were returned to CHD for the next 4 months (2nd CHD period). Results: We found no significant difference in the removal ratio of small uremic substances or the indices of inflammation or nutritional states between the pre-OL-HDF and CHD periods. However, we found higher removal of β2 micro-globulin in the pre-OL-HDF period, and the human mercapto-albumin (Alb)/human serum Alb ratio was significantly higher in the pre-OL-HDF period. Conclusion: Treatment with pre-OL-HDF enabled enhanced removal of middle molecule uremic toxins and better Alb redox than did CHD.

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“…Benefits of HDF have been ascribed to negative thermal balance due to the infusion of relatively cool substitution fluid. Interestingly, a recent prospective study showed that compared to high-flux HD, high-dose HDF was associated with preservation of muscle mass, increased protein intake and reduced inflammation, suggesting that HDF could help prevent protein-energy wasting [35].…”

mentioning

confidence: 99%

Is There Not Sufficient Evidence to Show That Haemodiafiltration Is Superior to Conventional Haemodialysis in Treating End-Stage Kidney Disease Patients?

et al. 2018

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The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study

Abstract: OL-HDF for 1 year compared with HF-HD preserved muscle mass, increased protein intake and reduced the inflammatory state related to uraemia and dialysis, supporting the hypothesis that high convection volume can benefit nutritional status and prevent protein-energy wasting in HD patients.

Cited by 60 publications

References 51 publications

Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients

Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients

Predilution On-Line Hemodiafiltration Improves Albumin Redox in Maintenance Hemodialysis Patients

Is There Not Sufficient Evidence to Show That Haemodiafiltration Is Superior to Conventional Haemodialysis in Treating End-Stage Kidney Disease Patients?

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