High cut-off dialysis in chronic hemodialysis XXXX .

@entity1 @entity32 @entity4619 @entity65
BACKGROUND: Hemodialysis @entity1 suffer from chronic systemic @entity32 and high incidence of @entity65 . One cause for this may be the failure of diseased kidneys to eliminate immune mediators. Current hemodialysis treatment achieves insufficient elimination of proteins in the molecular weight range 15-45kD. Thus high cut-off dialysis might improve the inflammatory state. DESIGN: In this randomized cross-over trial 43 hemodialysis @entity1 were treated for three weeks with high cut-off or high-flux dialysis. Inflammatory plasma mediators, monocyte subpopulation distribution, and leucocyte gene expression were quantified. RESULTS: High cut-off dialysis supplemented by a low-flux filter did not influence the primary end-point, expression density of @entity4619 on monocytes. Nevertheless, treatment reduced multiple immune mediators in plasma. Such reduction proved - at least for some markers - to be a sustained effect over the interdialytic interval. Thus, for example soluble TNF-Receptor1 concentration predialysis was reduced from median 13.3 (IQR 8.9-17.2) to 9.7 (IQR 7.5-13.2) ng/mL with high cut-off while remaining constant with high-flux treatment. The expression profile of multiple proinflammatory genes in leucocytes was significantly dampened. Treatment was well tolerated although albumin losses in high cut-off dialysis would be prohibitive against long-term use. CONCLUSIONS: The study shows for the first time that a dampening effect of high cut-off dialysis on systemic @entity32 is achievable. Earlier studies had failed due to short study duration or insufficient dialysis efficacy. Removal of soluble mediators from the circulation influences cellular activation levels in leucocytes. Continued development of less albumin leaky membranes with similar cytokine elimination is justified. This article is protected by copyright. All rights reserved.
