The Effects of Vitamin E-Coated Membrane Dialyzer Compared to Simvastatin in Patients on Chronic Hemodialysis

Abstract

Background: We investigated the effects of the use of vitamin E-coated membrane (VEM) dialyzer in comparison to simvastatin on markers of chronic inflammation, oxidative stress, and endothelial cell apoptosis in ten patients on chronic hemodialysis (HD), aiming at distinguishing the different treatment effects and their time sequence on these pathogenetic routes. Methods: Ten HD patients were sequentially submitted to a 6-month treatment with the use of VEM and 10 mg of simvastatin daily, interrupted by a 3-month washout period. At baseline, at 3, and 6 months of each trial, serum C-reactive protein (CRP), apolipoprotein (Apo) A1 and B, lipoprotein-a [Lp(a)], high-sensitivity interleukin-6 (hsIL-6), monocyte chemoattractant protein-1 (MCP-1), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), soluble Fas (sFas), soluble Fas ligand (sFasL), and plasma oxidized low-density lipoproteins (oxLDL) levels were determined. Results: VEM treatment resulted in a significant decrease in CRP, IL-6, sICAM-1 at 3 months, and oxLDL at 6 months, compared to baseline. Simvastatin resulted in a significant decrease in CRP, which correlated with decreases in both total (r ¼ 0.87, p < 0.05) and low-density lipoprotein cholesterol, IL-6, sICAM-1, sVCAM-1, oxLDL, and sFas at 6 months, compared to baseline. Simvastatin effects on sVCAM-1 (mean difference ¼ 652 ng/mL; 95% CI ¼ 294 to 2686; p < 0.05) and sFas (mean difference ¼ 1284 pg/mL; 95% CI ¼ 510 to 1910; p < 0.05) differed significantly from the corresponding VEM effects. Conclusions: The 6-month use of VEM resulted in more direct and immediate anti-inflammatory effects compared with those caused by the 6-month treatment with simvastatin. Simvastatin caused a more intense decrease in the markers of inflammation, which was in part correlated with its lipid-lowering effects.

Impact of inflammation on anti‐oxidative effects of vitamin E‐coated membrane dialyzer in patients on chronic hemodialysis

“…5 Recently, we and others have shown that the use of cellulose-based VEM exert significant anti-inflammatory and antioxidative effects in patients on HD, 6,7 reflected mainly on decreases in the levels of serum C-reactive protein (CRP), interleukin-6 (IL-6, and plasma oxidized low-density lipoproteins (oxLDL). Similar findings with the use of a newer polysulfone-based VEM were more recently found by Panichi et al 8 Triggered by our observation that antioxidative effects of VEM are preceded by their anti-inflammatory effects, 6,9 we performed the present secondary analysis to assess the probable association of antioxidative effects of VEM with the baseline inflammatory status, controlling for other established risk factors as well, in HD patients.…”

“…Similar findings with the use of a newer polysulfone‐based VEM were more recently found by Panichi et al . Triggered by our observation that antioxidative effects of VEM are preceded by their anti‐inflammatory effects, we performed the present secondary analysis to assess the probable association of antioxidative effects of VEM with the baseline inflammatory status, controlling for other established risk factors as well, in HD patients.…”

“…in a small study including only nine HD patients, who were among the first to report significant anti‐inflammatory in addition to the antioxidative effects of VEM whereas, more recently, the anti‐inflammatory effects of polysulfone‐based VEM have been confirmed as well . Triggered by our observation that antioxidative effects of VEM are preceded by their anti‐inflammatory effects, we performed the present analysis to assess the probable impact of the baseline inflammatory status on the antioxidative effects from the use of a VEM. The results presented herein are compatible with the hypothesis that the antioxidative benefits from VEM treatment are secondary to its anti‐inflammatory and, therefore, they might be observed preferentially or even exclusively in specific patient populations, such as diabetics or end‐stage renal disease patients, i.e.…”