Water-Soluble Vitamins and Trace Elements Losses during On-Line Hemodiafiltration

Abstract

Maintenance hemodialysis induces water-soluble vitamins and trace elements losses, which is why recommendations regarding potential supplementation were provided, but mainly based on conventional hemodialysis. This study′s aim was to measure the water–soluble vitamins and trace element losses during one on-line post-dilution hemodiafiltration (HDF) session. Thirty-nine patients under maintenance HDF were enrolled. We used the Theraflux® sampler (Theradial Corp., Orvault, France) to analyze the full session dialysate mass transfer. Blood and dialysate samples were collected before and after one HDF session to measure B1, B2, B6, B9, B12, C vitamins, zinc, and selenium concentrations. Values significantly decreased for B1 (20.2%), B2 (13%), B6 (25.4%), B9 (32.6%), C (66.6%) and selenium (6.7%). No significant differences were found for vitamin B12 and zinc. The dialysate losses per session were 1.12 ± 0.88 mg for vitamin B1, 0.28 ± 0.30 mg for B2, 0.33 ± 0.09 mg for B6, 0.3 ± 0.18 mg for B9, 147.5 ± 145.50 mg for C and 25.75 ± 6.91 mg for zinc. Vitamin B12 and selenium were under detection values. In conclusion, during a standard 4hr-HDF session, we found important losses for vitamin B1, B6, B9, C and zinc, suggesting the need for regular monitoring of plasma levels and systematic supplementation of these compounds.

Water-Soluble Vitamins Status in Patients Undergoing Maintenance Hemodialysis

“…The first article about vitamins and minerals lost during HD was published in the 1980s [ 23 ]. Another study found important losses of water-soluble vitamins (B 1 , B 6 , B 9 , and C) during a standard 4 h hemodiafiltration session [ 24 ]. Schwotzer et al found that the levels of most vitamins are above the normal range in patients on hemodiafiltration receiving a classic dose of vitamin supplements, vitamin C excepted [ 25 ].…”

“…Thiamine stores are low and the use of an improperly balanced diet for several weeks can lead to its deficiency, especially in the case of HD patients, because the hemodialysis procedure causes the loss of this vitamin. The loss of vitamin B 1 during dialysis depends on the duration of the procedure and the type of hemodialysis used [ 6 , 24 ]. Jankowska et al measured that thiamine diphosphate (TDP), a bioactive compound of vitamin B 1 , is substantially lost during the HD procedure, and the amount of its loss is associated with body weight.…”

“…In our previous study from 2016, we observed that 48% of HD patients had inadequate dietary vitamin B 2 intake [ 35 ], and in a study by other authors, the intake was too low in about 25% of patients [ 36 ]. Bevier et al observed during the dialysis procedure the loss of vitamin B 2 is 13% [ 24 ]. For this reason, it is necessary to watch the intake of this vitamin along with the diet.…”

“…In our previous study, we observed that 40% of HD patients had low dietary vitamin B 6 intake [ 34 ]. Bevier et al found that vitamin B 6 concentrations decreased by 25.4% after one dialysis session [ 24 ]. In our study, the HD group had significantly lower levels of this vitamin than the control group (0.14 ± 0.16 ng/μL vs. 0.5 ± 0.26 ng/μL).…”

“…Intestinal bacteria also synthesize folate. Bevier et al and Schwotzer et al described vitamin B 9′ s important losses per season [ 24 , 25 ]. Coveney et al found that extended hours of dialysis did not have an impact on serum levels of folate in 52 HD patients, 38% of whom were taking a multivitamin [ 7 ].…”