NDLI: High-ef fi ciency on-line haemodia fi ltration improves conduit artery endothelial function compared with high-fl ux haemodialysis in end-stage renal disease patients

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High-ef fi ciency on-line haemodia fi ltration improves conduit artery endothelial function compared with high-fl ux haemodialysis in end-stage renal disease patients

Content Provider	Semantic Scholar
Author	Bellien, Jeremy Fréguin-Bouilland, Caroline Joannidés, Robinson Hanoy, Mélanie Rémy-Jouet, Isabelle Monteil, Christelle Iacob, Michèle Martin, Laurent Renet, Sylvanie Vendeville, Cathy Godin, Michel Thuillez, Christian Roy, Frank Le
Copyright Year	2014
Abstract	Background. Middle molecular weight uraemic toxins are considered to play an important role in vascular dysfunction and cardiovascular outcomes in end-stage renal disease (ESRD) patients. Recent dialysis techniques based on convection, specifically high-efficiency on-line haemodiafiltration (HDF), enhance the removal of middle molecular weight toxins and reduce all-cause mortality in haemodialysis (HD) patients. However, the mechanisms of these improved outcomes remain to be established. Methods. This prospective study randomly assigned 42 ESRD patients to switch from high-flux HD to high-efficiency online HDF (n = 22) or to continue HD (n = 20). Brachial artery endothelium-dependent flow-mediated dilatation, central pulse pressure, carotid artery intima-media thickness (IMT), internal diastolic diameter and distensibility and circulating markers of uraemia, inflammation and oxidative stress were blindly assessed before and after a 4-month follow-up. Results. Brachial flow-mediated dilatation and carotid artery distensibility increased significantly in the HDF group compared with HD, while carotid IMT and diameter remained similar. HDF decreased predialysis levels of the uraemic toxins β2-microglobulin, phosphate and blood TNFα mRNA expression. Oxidative stress markers were not different between the HD and HDF groups. Blood mRNA expression of protein kinase C β2, an endothelial NO-synthase (eNOS) inhibitor, decreased significantly with HDF. Conclusions. High-efficiency on-line HDF prevents the endothelial dysfunction and stiffening of the conduit arteries in ESRD patients compared with high-flux HD. HDF decreases uraemic toxins, vascular inflammation, and is associated with subsequent improvement in eNOS functionality. These results suggest that reduced endothelial dysfunction may be an intermediate mechanism explaining the beneficial outcomes associated with HDF.
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Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article

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