Online hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis

被引:91
作者
den Hoedt, Claire H. [1 ,2 ]
Bots, Michiel L. [3 ]
Grooteman, Muriel P. C. [4 ,5 ]
van der Weerd, Neelke C. [6 ]
Mazairac, Albert H. A. [2 ]
Penne, E. Lars [4 ]
Levesque, Renee [7 ]
ter Wee, Piet M. [4 ,5 ]
Nube, Menso J. [4 ,5 ]
Blankestijn, Peter J. [2 ]
van den Dorpel, Marinus A. [1 ]
机构
[1] Maasstad Hosp, Dept Internal Med, NL-3007 AC Rotterdam, Netherlands
[2] Univ Med Ctr Utrecht, Dept Nephrol, Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
[4] Vrije Univ Amsterdam Med Ctr, Dept Nephrol, Amsterdam, Netherlands
[5] Vrije Univ Amsterdam Med Ctr, Inst Cardiovasc Res VU Med Ctr ICaR VU, Amsterdam, Netherlands
[6] Univ Amsterdam, Acad Med Ctr, Dept Nephrol, NL-1105 AZ Amsterdam, Netherlands
[7] St Luc Hosp, Dept Nephrol, Montreal, PQ, Canada
关键词
hemodiafiltration; hemodialysis; inflammation; C-REACTIVE PROTEIN; ALL-CAUSE MORTALITY; CARDIOVASCULAR MORTALITY; EFFICIENCY; DISEASE; ERYTHROPOIETIN; PARAMETERS; CYTOKINES; REMOVAL; ALBUMIN;
D O I
10.1038/ki.2014.9
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Online hemodiafiltration may diminish inflammatory activity through amelioration of the uremic milieu. However, impurities in water quality might provoke inflammatory responses. We therefore compared the long-term effect of low-flux hemodialysis to hemodiafiltration on the systemic inflammatory activity in a randomized controlled trial. High-sensitivity C-reactive protein and interleukin-Were measured for up to 3 years in 405 patients of the CONvective TRAnsport STudy, and albumin was measured at baseline and every 3 months in 714 patients during the entire follow-up. Differences in the rate of change over time of C-reactive protein, interleukin-6, and albumin were compared between the two treatment arms. C-reactive protein and interleukin-6 concentrations increased in patients treated with hemodialysis, and remained stable in patients treated with hemodiafiltration. There was a statistically significant difference in rate of change between the groups after adjustments for baseline variables (C-reactive protein difference 20%/year and interleukin-6 difference 16%/year). The difference was more pronounced in anuric patients. Serum albumin decreased significantly in both treatment arms, with no difference between the groups. Thus, long-term hemodiafiltration with ultrapure dialysate seems to reduce inflammatory activity over time compared to hemodialysis, but does not affect the rate of change in albumin.
引用
收藏
页码:423 / 432
页数:10
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