ESPN 50th Annual Meeting

ESPN 2017


 
Hemodiafiltration is associated with reduced inflammation and oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children
AYŞE AĞBAŞ 1 NUR CANPOLAT 1 SALIM ÇALIŞKAN 1 ALEV YILMAZ 2 HAKAN EKMEKÇI 3 MARK MAYES 4 HELEN AITKENHEAD 5 LALE SEVER 1 RUKSHANA SHROFF 6

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY, ISTANBUL UNIVERSITY CERRAHPASA FACULTY OF MEDICINE, ISTANBUL, TURKEY
2- DEPARTMENT OF PEDIATRIC NEPHROLOGY, ISTANBUL UNIVERSITY ISTANBUL FACULTY OF MEDICINE, ISTANBUL, TURKEY
3- DEPARTMENT OF BIOCHEMISTRY, ISTANBUL UNIVERSITY CERRAHPASA FACULTY OF MEDICINE, ISTANBUL, TURKEY
4- GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, LONDON, UNITED KINGDOM
5- DEPARTMENT OF CHEMICAL PATHOLOGY, GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, LONDON, UNITED KINGDOM
6- DEPARTMENT OF PEDIATRIC NEPHROLOGY, GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, LONDON, UNITED KINGDOM
 
Introduction:

Randomised trials in adults have shown reduced all-cause and cardiovascular mortality on hemodiafiltration (HDF) compared to conventional hemodialysis (HD), but the mechanisms for improved outcome are not clear and pediatric data is scarce. 

Material and methods:

We studied non-traditional cardiovascular risk factors of inflammatory (IL-6, hsCRP, pentraxin-3, LP-PLA2), anti-inflammatory (IL-10), oxidative stress (nitrotyrosine), anti-oxidant capacity [Total antioxidant capacity (TAC)] and endothelial (ADMA, SDMA, oxidized LDL) markers in 22 children (13 female, aged between 8.9-15) on HD and HDF in two tertiary dialysis units in London and Istanbul. All children received HD for at least 3 months, and then switched to HDF. 

Results:

None of the measures, except IL-10 levels, correlated with time on dialysis, suggesting that even a short dialysis vintage of 3 months on HD increases inflammatory and endothelial markers. After 3-months of switching to HDF there was a significant improvement in Beta2 microglobulin (B2m), IL-10, hsCRP, ADMA, SDMA, AGE,  ox-LDL and TAC (Table-1). HDF was associated with a significant reduction in ADMA, SDMA, hs-CRP and AGE even in children with a urine output >200ml compared to those with <200ml urine per day. The clearance of these markers was not associated with the type of vascular access, but children with a lower blood flow rate had higher inflammatory status (higher IL-6/IL-10 ratio; p= 0.045, r= -0.431). Children with a higher convective volume (higher than median 12.8L/m2) had lower Ox-LDL (p=0.024), compared to those who achieved a lower convective volume.

The TAC in HDF was comparable to levels in a cohort of CKD2 patients (p= 0.08) but other endothelial markers (ADMA, SDMA, ox-LDL) were significantly higher on HDF than CKD2 (p<0.01 for all).

Table 1: Comparison of the inflammatory and oxidative stress marker between HD and HDF in patients .

n=22

HD

median(IQR)

 

HDF

median(IQR)

 

p value*

LP-PLA2, ng/mL

333 (294-412)

372 (278-424)

  0.465

Nitrotyrosine, nM/ml

28.5 (23.7-56)

32 (24.4-43.7)

  0.370

Total antioxidant capacity, mmol/L

0.43 (0.40-0.72)

1.68 (0.42-2.39)

<0.001

Pentraxim-3, ng/mL

1.29 (0.49-1.91)

1.09 (0.63-1.66)

  0.641

IL-6, pg/mL

3.72 (2.34-8.36)

3.76 (2.37-8.86)

  0.499

IL-10, pg/mL

8.93 (3.81-146)

5.73 (4.39-10.4)

  0.030

Oxidized LDL,ng/mL

278 (203-384)

172 (114-211)

  0.001

ADMA, µmol/L

1.03 (0.92-1.21)

0.85 (0.75-1.02)

  0.001

SDMA, µmol/L

3.54 (2.46-3.54)

2.58 (2.12-3.12)

  0.003

hsCRP, mg/L

2.80 (1.95-3.16)

1.92 (0.70-2.43)

  0.002

AGEs, ng/mL

1338 (1221-1490)

982 (1029-1221)

  0.001

B2 microglobulin, mg/L

38.5 (33-43)

22.5 (16-26.2)

<0.001

*Wilcoxon signed ranks test

HD: hemodialysis, HDF: hemodiafiltration, LP-PLA2: lipoprotein phospholipase A2, ADMA: Asymmetric dimethylarginine, SDMA: symmetric dimethylarginine, AGEs: Advanced glycation end products.

Conclusions:

A significant improvement in inflammation, antioxidant capacity and endothelial risk profile is seen even within a short time (3 months) of HDF compared to HD treatment.