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Effect of hemodialysis and hemodiafiltration on uremic neuropathy
F Malberti1, M Surian, M Farina
1Department of Nephrology, Ospedale Maggiore, Lodi, Italy.
Insights
Hemodiafiltration (HDF) may prevent worsening peripheral neuropathy in patients undergoing chronic dialysis compared to hemodialysis (HD). HDF offers superior clearance of larger molecules, potentially preserving nerve function during long-term treatment.
Area of Science:
- Nephrology
- Neurology
- Biomedical Engineering
Background:
- Chronic kidney disease patients often develop uremic neuropathy.
- Hemodialysis (HD) is a common treatment, but its long-term effects on neuropathy are a concern.
- Hemodiafiltration (HDF) offers enhanced solute clearance, potentially mitigating complications.
Purpose of the Study:
- To compare the 1-year effect of HDF versus HD on peripheral neuropathy.
- To evaluate changes in electroneurographic parameters between HD and HDF treatments.
- To assess the impact of HDF on middle and larger molecule removal.
Main Methods:
- A prospective study comparing 21 patients on HD with 21 switched to HDF.
- Standardized dialysis parameters were maintained, with HDF utilizing a polysulfone dialyzer and higher substitution volume.
- Electroneurographic parameters and serum markers (including beta-2-microglobulin) were monitored over 1 year.
Main Results:
- HDF demonstrated significantly greater weekly inulin clearance than HD (p < 0.001).
- Beta-2-microglobulin levels were significantly reduced in the HDF group compared to the HD group (p < 0.01).
- HD patients showed significant declines in nerve conduction velocities and action potential amplitudes, while HDF patients did not.
Conclusions:
- HDF may prevent the progression of uremic neuropathy observed with chronic HD.
- Enhanced removal of middle and larger molecules by HDF likely contributes to preserving nerve function.
- The use of biocompatible membranes in HDF may further benefit uremic neuropathy outcomes.
Abstract:
This study was undertaken to compare the effect of 1 year hemodialysis (HD) or hemodiafiltration (HDF) treatment on peripheral neuropathy. Thus 21 of 42 patients on chronic HD (1-1.3 m2 cuprophane dialyzer, Qb 300 ml/min) were switched to HDF (1.3 m2 polysulfone dialyzer, Qb 400 ml/min, substitution volume 9-13 liters, ultrafiltration rate 60-70 ml/min), while the remaining patients were considered as a control group. Treatment time was scheduled both in HD and HDF to maintain adequate BUN levels in relation to protein catabolic rate. However, HDF provided a significantly greater weekly inulin (MW 5,000) clearance than HD (5.8 +/- 1.2 vs. 1.6 +/- 0.2 ml/min; p less than 0.001). HD and HDF groups were comparable for age, time on dialysis and starting electroneurographic parameters, which were on average within the normal range. After 1 year follow-up, creatinine, hematocrit, calcium, phosphate, PTH, BUN, protein catabolic rate and residual GFR were comparable in the two groups, whereas beta 2-microglobulin was significantly reduced in HDF patients (29 +/- 6.7 vs. 38.8 +/- 13.9 mg/l in HD patients, p less than 0.01). During the 1-year treatment, electroneurographic parameters did not change in HDF patients, whereas a significant decrease of ulnar motor nerve conduction velocity, ulnar muscle action potential amplitudes, median sensory nerve conduction velocity and peroneal muscle action potential amplitudes was detected in HD patients. We conclude that HDF might prevent the worsening of the electroneurographic indices occurring during chronic HD treatment, as it provides a more effective removal of middle and larger molecules than HD. The use of a more biocompatible membrane in HDF might further contribute to this favorable effect on uremic neuropathy.