Online hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis


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-6 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.


Authors: Claire H den Hoedt, Michiel L Bots, Muriel P C Grooteman, Neelke C van der Weerd, Albert H A Mazairac, E. Lars Penne, Ren?e Levesque, Piet M ter Wee, Menso J Nub?, Peter J Blankestijn and Marinus A van den Dorpel for the CONTRAST Investigators

Reference: Kidney Int 86: 423-432; advance online publication, February 19, 2014; doi:10.1038/ki.2014.9


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