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Toxin Removal and Inflammatory State Modulation during Online Hemodiafiltration Using Two Different Dialyzers (TRIAD2
Gabriele Donati1, Maria Cappuccilli1, Chiara Donadei1
1Department of Experimental, Diagnostic and Specialty Medicine (DIMES)-Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital IRCCS, University of Bologna, 40138, Bologna, Italy.
Methods and Protocols
|April 30, 2021
Summary
This study compares two online hemodiafiltration (HDF) dialyzers: polysulfone and cellulose triacetate (ATA). It assesses their effectiveness in removing uremic toxins and reducing inflammation in dialysis patients over 24 months.
Area of Science:
- Nephrology
- Biomaterials Science
- Cardiovascular Medicine
Background:
- Uremic toxins are key contributors to atherosclerosis and cardiovascular risk in dialysis patients.
- Online hemodiafiltration (HDF) improves clearance of middle- and large-molecular-weight solutes, potentially reducing cardiovascular mortality.
- Dialyzer membrane properties significantly influence solute removal and patient outcomes.
Purpose of the Study:
- To compare the efficacy of a polysulfone-based high-flux membrane versus an asymmetric triacetate (ATA) membrane in online HDF.
- To evaluate the impact of these dialyzers on uremic toxin removal and inflammatory status in hemodialysis patients.
- To investigate the in vitro effects of patient serum, treated with different dialyzers, on endothelial cell function.
Main Methods:
- A 24-month, non-randomized, open-label observational study involving 32 hemodialysis patients switched to online HDF.
- Patients were divided into two groups: Group A (polysulfone filter) and Group B (ATA filter), based on hypersensitivity history.
- Monthly assessments included toxin levels, inflammation markers, oxidative stress, immune cell subsets, apoptosis, advanced glycation end-products (AGEs), arterial stiffness (PWV), and mortality.
Main Results:
- The study aims to provide a better understanding of the differential effects of polysulfone and ATA membranes on uremic toxin clearance.
- It will elucidate the impact of blood-membrane interactions on inflammatory status and patient-specific outcomes.
- In vitro analysis will assess serum-induced changes in endothelial cell behavior and gene/protein expression.
Conclusions:
- The findings will offer insights into the comparative performance of established and novel dialyzer membranes in online HDF.
- This research is expected to inform clinical decisions regarding dialyzer selection for optimizing patient care and reducing cardiovascular risk.
- Understanding membrane-specific effects on uremic toxin profiles and inflammation is crucial for advancing hemodialysis therapy.
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