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High cut-off dialysis in chronic haemodialysis patients reduces serum procalcific activity

Daniel Zickler1, Kevin Willy1, Matthias Girndt2

  • 1Department of Nephrology and Internal Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|July 23, 2016
PubMed

Insights

High cut-off (HCO) dialysis membranes reduce vascular calcification in chronic dialysis patients. This study found HCO membranes lowered vascular cell adhesion molecule 1 (VCAM-1) levels, a key factor in calcification, suggesting improved treatment outcomes.

Area of Science:

  • Nephrology
  • Vascular Biology
  • Biomedical Engineering

Background:

  • Chronic dialysis patients exhibit enhanced vascular calcification, potentially due to inadequate removal of uremic toxins by conventional membranes.
  • Intermediate molecular weight toxins, including interleukins, may contribute to vascular calcification in dialysis patients.

Purpose of the Study:

  • To assess the impact of high cut-off (HCO) membranes on in vitro vascular calcification in chronic dialysis patients.
  • To investigate the role of specific mediators, such as VCAM-1, in dialysis-induced vascular calcification.

Main Methods:

  • A randomized crossover trial (PERCI trial) involving 43 chronic dialysis patients using conventional high-flux and HCO filters.
  • Incubation of calcifying human coronary vascular smooth muscle cells (VSMCs) with patient serum samples post-dialysis.
  • Assessment of calcification using alkaline phosphatase (ALP) and alizarin red staining; measurement of serum mediator levels (sTNFR1, sTNFR2, VCAM-1, sIL2R).

Main Results:

  • HCO dialysis significantly reduced serum levels of sTNFR1, sTNFR2, VCAM-1, and sIL2R compared to high-flux dialysis.
  • VSMCs incubated with serum from HCO dialysis showed a 26% reduction in ALP and a 43% reduction in alizarin staining compared to high-flux serum.
  • VCAM-1 demonstrated a dose-dependent enhancement of VSMC calcification in vitro, while sIL2R, sTNFR1, and sTNFR2 had no significant effect.

Conclusions:

  • High cut-off (HCO) dialysis membranes effectively reduce the procalcific effects of serum on VSMCs in vitro.
  • Lowered VCAM-1 levels in HCO serum may contribute to the observed reduction in vascular calcification.
  • Further research into highly permeable filters like HCO membranes is warranted for chronic dialysis patients to mitigate vascular calcification.
Abstract

Keywords:
atherosclerosischronic haemodialysiscoronary artery diseaseinflammationvascular calcification

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