Elsevier

Kidney International

Volume 86, Issue 2, August 2014, Pages 423-432
Kidney International

Clinical Trial
Online hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis

https://doi.org/10.1038/ki.2014.9Get rights and content
Under an Elsevier user license
open archive

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.

KEYWORDS

hemodiafiltration
hemodialysis
inflammation

Cited by (0)

CHdH, MLB, NCvdW, AHAM, ELP, RL, PJB and MAvdD report receiving no lecture fees, no consulting support, or grant support. MPCG reports to be under negotiation for grant support from Fresenius Medical Care and reports receiving lecture fees from Fresenius Medical Care BV, The Netherlands. PMtW reports consulting support by Amgen and Sanofi and grant support from the Dutch Kidney Foundation. MJN reports to be under negotiation for grant support from Fresenius Medical Care.

8

See Appendix for list of CONTRAST investigators.