Abstract: FR-PO856

Hemodiafiltration Is Associated with Reduced Inflammation and Oxidative Stress and Improved Endothelial Risk Profile Compared to High-Flux Hemodialysis in Children

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Agbas, Ayse, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  • Canpolat, Nur, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  • Caliskan, Salim, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  • Yilmaz, Alev, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
  • Ekmekçi, Hakan, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  • Mayes, Mark, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
  • Aitkenhead, Helen, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
  • Sever, Lale, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  • Shroff, Rukshana, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
Background

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

Methods

We studied CV risk factors for inflammation, oxidative stress, antioxidant capacity and endothelial function in 22 children (13 female, age 8.9 - 15.5 years) in two dialysis units. All children received HD for at least 3 months, and were then switched to HDF. Biochemical measures were performed after 3 months on HD followed by 3 months on HDF.

Results

After 3-months on HDF there was a significant improvement in ß2 microglobulin, IL-10, hsCRP, ADMA, SDMA, AGE, ox-LDL and TAC compared to levels on HD (Table). HDF was associated with a significant reduction in ADMA, SDMA, hs-CRP and AGE even in children with residual renal function. Clearance was not associated with the type of vascular access, but children with a lower blood flow had higher inflammatory status (higher IL-6/IL-10 ratio; p=0.045, r=-0.431). Children with a higher convective volume (≥median 12.8L/m2) had lower Ox-LDL (p=0.024). 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.

Conclusion

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.

n=22HemodialysisHemodiafiltration*p value
Nitrotyrosine, nM/ml28.5 (23.7-56)32 (24.4-43.7)0.370
Total antioxidant capacity, mmol/L0.43 (0.40-0.72)1.68 (0.42-2.39)<0.001
Pentraxim-3, ng/mL1.29 (0.49-1.91)1.09 (0.63-1.66)0.641
Interleukine-6, pg/mL3.72 (2.34-8.36)3.76 (2.37-8.86)0.499
High sensitive C-reactive protein, mg/L2.80 (1.95-3.16)1.92 (0.70-2.43)0.002
Interleukine-10, pg/mL8.93 (3.81-146)5.73 (4.39-10.4)0.030
Lipoprotein phospholipase A2, ng/mL333 (294-412)372 (278-424)0.465
Oxidized low density lipoprotein,ng/mL278 (203-384)172 (114-211)0.001
Asymmetric dimethylarginine, µmol/L1.03 (0.92-1.21)0.85 (0.75-1.02)0.001
Symmetric dimethylarginine, µmol/L3.54 (2.46-3.54)2.58 (2.12-3.12) 0.003
Advanced glycation end-products, ng/mL1338 (1221-1490)982 (1029-1221)0.001
Beta 2 microglobulin, mg/L38.5 (33-43)22.5 (16-26.2)<0.001

* Wilcoxon signed-rank test, median (IQR)

Funding

  • Government Support - Non-U.S.