Vitamin e-loaded membrane dialyzers reduce hemodialysis inflammaging

Abstract

BackgroundInflammaging is a persistent, low−grade, sterile, nonresolving inflammatory state, associated with the senescence of the immune system. Such condition downregulates both innate and adaptive immune responses during chronic disorders as type II diabetes, cancer and hemodialysis, accounting for their susceptibility to infections, malignancy and resistance to vaccination.Aim of this study was to investigate hemodialysis inflammaging, by evaluating changes of several hemodialysis treatments on indoleamine 2,3-dioxygenase-1 activity and nitric oxide formation.MethodsWe conducted a randomized controlled observational crossover trial. Eighteen hemodialysis patients were treated with 3 different hemodialysis procedures respectively: 1) Low−flux bicarbonate hemodialysis, 2) Low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers, and 3) Hemodialfitration. The control group consisted of 14 hospital staff healthy volunteers. Blood samples were collected from all 18 hemodialysis patients just after the long interdialytic interval, at the end of each hemodialysis treatment period.ResultsHemodialysis kynurenine and kynurenine/L − tryptophan blood ratio levels were significantly higher, when compared to the control group, indicating an increased indoleamine 2,3-dioxygenase-1 activity in hemodialysis patients. At the end of the low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers period, L − tryptophan serum levels remained unchanged vs both low−flux bicarbonate hemodialysis and hemodialfitration. Kynurenine levels instead decreased, resulting in a significant reduction of kynurenine/L − tryptophan blood ratio and indoleamine 2,3-dioxygenase-1 activity, when matched to both low−flux bicarbonate hemodialysis and HDF respectively. Serum nitric oxide control group levels, were significantly lower when compared to all hemodialysis patient groups. Interestingly, low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers nitric oxide serum levels from venous line blood samples taken 60 min after starting the hemodialysis session were significantly lower vs serum taken simultaneously from the arterial blood line.ConclusionsThe treatment with more biocompatible hemodialysis procedure as low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers, reduced indoleamine 2,3-dioxygenase-1 activity and nitric oxide formation when compared to both low−flux bicarbonate hemodialysis and hemodialfitration. These data suggest that low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers lowering hemodialysis inflammaging, could be associated to changes of proinflammatory signalling a regulated molecular level.Trial registrationNCT Number: NCT02981992; Other Study ID Numbers: 20100014090. First submitted: November 26, 2016. First posted: December 5, 2016. Last Update Posted: December 5, 2016.

Effects of Different Dialysis Strategies on Inflammatory Cytokine Profile in Maintenance Hemodialysis Patients with COVID-19: A Randomized Trial

“…However, considering that the absolute levels of many cytokines were not so dissimilar between COVID-19 patients and controls, and mainly evaluating the time trend of inflammatory molecules, it appears that HD patients had a blunted immune response to COVID-19. The lack of a marked elevation of inflammatory cytokines during COVID-19 in HD patients is not surprising and may represent an expression of the so-called inflammaging [ 27 ]. This phenomenon refers to the premature aging of the immune system found in HD patients, and it is characterized by the chronic activation of the immune system, increased oxidative stress, and low-grade systemic inflammation [ 28 ].…”

Oxidative Stress in Patients with Advanced CKD and Renal Replacement Therapy: The Key Role of Peripheral Blood Leukocytes

“…and the HD modality (e.g., low-and high-flux HD, hemodiafiltration, etc.) [37][38][39][40]. However, these reports are not clear, showing increased, decreased or no changes in the oxidative-inflammatory stress parameters analyzed [37][38][39][40].…”

Updates on hemodialysis techniques with a common denominator: The personalization of the dialytic therapy

“…In particular, oxide nitric plasma formation was significantly reduced after VIT-E treatment when compared to bicarbonate HD and HDF patients. 101 Moreover, VIT-E has been related…”

“…Moreover, the local availability of abundant vitamin E anchored to dialysis membrane may have been particularly effective in contrasting dialysis reactive oxygen species generation. In particular, oxide nitric plasma formation was significantly reduced after VIT‐E treatment when compared to bicarbonate HD and HDF patients 101 . Moreover, VIT‐E has been related to improved levels of surrogate markers of inflammation, such as C‐reactive protein and interleukin‐6, with positive effects on erythropoietin resistance index (ERI) and erythropoietin dosage 102 .…”