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Effects of Different Dialysis Strategies on Inflammatory Cytokine Profile in Maintenance Hemodialysis Patients with

Pasquale Esposito1,2, Leda Cipriani1, Daniela Verzola1

  • 1Department of Internal Medicine, University of Genova, 16132 Genova, Italy.

Journal of Clinical Medicine
|April 3, 2021
PubMed

Insights

In hemodialysis patients with COVID-19, inflammation is not sustained. Expanded hemodialysis (HDx) showed a decrease in interleukin-10 (IL-10) levels, unlike standard treatment. Therapeutic modulation of inflammation is not a viable target in this patient group.

Area of Science:

  • Nephrology
  • Immunology
  • Infectious Diseases

Background:

  • Uncontrolled inflammation is implicated in COVID-19 pathogenesis.
  • Hemodialysis (HD) patients represent a vulnerable population for severe COVID-19 outcomes.
  • Understanding inflammatory marker dynamics in HD patients with COVID-19 is crucial.

Purpose of the Study:

  • To investigate the time trend of inflammatory markers in maintenance HD patients with COVID-19.
  • To compare the effects of expanded hemodialysis (HDx) versus standard protein-leaking dialyzer (PLD) treatment on inflammatory markers.
  • To determine if modulating inflammation is a suitable therapeutic target in this population.

Main Methods:

  • Prospective study involving 31 maintenance HD patients with COVID-19.
  • Randomization to either HDx (medium cut-off membrane) or PLD treatment.
  • Measurement of circulating levels of IL-6, IL-8, IL-10, sTLR4, and IFN-γ at diagnosis, and at one and two weeks post-diagnosis.

Main Results:

  • COVID-19 patients exhibited lymphopenia and elevated ferritin and lactate dehydrogenase compared to non-infected HD patients.
  • COVID-19 patients presented higher baseline IL-10 levels.
  • While IL-8 decreased in both HDx and PLD groups, IL-10 reduction was observed only in the HDx group after a single treatment. No significant sustained differences in cytokine levels were found between HDx and PLD groups over the study period. No correlations between cytokine levels and clinical outcomes were identified.

Conclusions:

  • COVID-19 in maintenance HD patients is not characterized by a sustained inflammatory response.
  • The observed inflammatory profile suggests that therapeutic modulation of inflammation may not be an effective strategy for COVID-19 in this specific patient cohort.
  • Expanded hemodialysis (HDx) may influence specific cytokine dynamics, but overall inflammatory modulation is not a primary therapeutic target.

Keywords:
COVID-19cytokinesexpanded hemodialysishemodialysisinflammagingprotein-leaking dialyzer

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