Effects of medium cut-off dialysis membranes on inflammation and oxidative stress in patients on maintenance hemodialysi
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NEPHROLOGY - ORIGINAL PAPER
Effects of medium cut‑off dialysis membranes on inflammation and oxidative stress in patients on maintenance hemodialysis Hasan Haci Yeter1 · Berfu Korucu1 · Omer Faruk Akcay · Kursat Derici2 · Ulver Derici1 · Turgay Arinsoy Received: 21 April 2020 / Accepted: 29 June 2020 © Springer Nature B.V. 2020
Abstract Purpose Medium cut-off membranes were developed for providing increased clearance of larger middle-molecule uremic toxins. We compared the effect of low-flux, medium cut-off, and high-flux membranes on chronic inflammation and oxidative stress in patients with maintenance hemodialysis. Methods A total of 42 patients were enrolled in this study. Total antioxidant status, total oxidant status, paraoxonase-1, ischemia-modified albumin, total Thiol, disulfide bond, and native Thiol were measured to determine oxidative stress. C-reactive protein was measured to define inflammation. Results 37% of the total patients were females, and the mean age was 52.9 ± 16 years. Serum albumin and Kt/V were similar between groups during the study period. We did not find any significant difference at baseline in the 3rd and 6th months of the study when we compared the inflammatory marker and oxidative indicator levels between three hemodialysis membranes in the whole study group. In the subgroup analysis of 19 patients with a high C-reactive protein level, we found that the medium cut-off membrane significantly reduced serum C-reactive protein level, when compared to low-flux and high-flux membrane [2.8 mg/L vs. 13.7 mg/L and 6.1 mg/L, respectively, p = 0.05]. However, we did not find a significant change in oxidative stress indicators in patients with high C-reactive protein levels between the three dialysers. Conclusion The medium cut-off membrane has favorable effects on inflammation in patients with maintenance hemodialysis. However, this positive effect could not be demonstrated in oxidative stress. Keywords Expanded hemodialysis · Hemodialysis · Inflammation · Medium cut-off dialyser · Oxidative stress
Introduction Patients with end-stage renal disease undergoing intermittent hemodialysis (HD) have a higher morbidity and mortality risk due to cardiovascular diseases despite the remarkable developments in the HD field [1]. It is demonstrated that animal models and patients with chronic kidney disease (CKD) have high plasma concentration of inflammatory markers such as C-reactive protein (CRP) and reactive oxygen species (ROS) [2, 3]. Excessive ROS could lead to oxidation of lipids, proteins, and DNA [4]. The development of cardiovascular disease (CVD) could be facilitated by these * Hasan Haci Yeter [email protected] 1
Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
Department of Medical Pharmacology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
2
oxidation products, which is triggered by ROS and chronic inflammation [4]. On the contrary, antioxidant molecules prevent and/or inhibit ROS, and it is demonstrated that total antioxi
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