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High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: a post-hoc analysis from the HDFit randomized controlled trial.
J Nephrol. 2022 06; 35(5):1449-1456.JN

Abstract

BACKGROUND

Although high-volume online hemodiafiltration has been associated with higher clearance and lower pre-dialysis concentration of middle molecular weight toxins compared to hemodialysis, its effect on protein-bound uremic toxins has shown inconclusive results. In this study, we investigated whether hemodiafiltration impacts pre-dialysis plasma levels of the toxins indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid compared to high-flux hemodialysis.

METHODS

This is a post-hoc analysis of the multicenter, randomized controlled trial HDFit (ClinicalTrials.gov: NCT02787161). Uremic toxins were determined by high performance liquid chromatography at baseline, 3, and 6 months. Mean differences in monthly changes of pre-dialysis uremic toxin concentrations between hemodiafiltration and high-flux hemodialysis were analyzed using linear mixed-effect models.

RESULTS

One hundred ninety-three patients (mean age 53 years old, 71% males) were analyzed. There were no differences between groups regarding clinical and biochemical characteristics at baseline or duration of dialysis session and blood flows throughout the follow-up. Mean differences in rates of change (μM/month, [confidence interval CI]) in high-flux hemodialysis vs. hemodiafiltration were 2.4 [0.3 to 4.56], 3.94 [- 1.54 to 9.41] and 0.06 [- 0.6 to 0.5] for indoxyl sulfate, p-cresyl sulfate and indole-3-acetic acid, respectively. In the exploratory analysis, these differences in high-flux hemodialysis vs. hemodiafiltration subgroup with convective volume > 27.5 L were 2.86 [0.43 to 5.28], 7.43 [0.7 to 14.16] and - 0.19 [- 0.88 to 0.50].

CONCLUSION

These exploratory findings suggest that hemodiafiltration is more effective in reducing indoxyl sulfate as compared to standard high-flux hemodialysis, and also that this effect was extended to p-cresyl sulfate in patients achieving higher convective volumes.

Authors+Show Affiliations

Department of Basic Pathology, Universidade Federal do Paraná, Curitiba, Brazil.School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.Department of Basic Pathology, Universidade Federal do Paraná, Curitiba, Brazil.School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.Fresenius Medical Care, Rio de Janeiro, Brazil.Universidade Federal de São Paulo, São Paulo, Brazil.Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. Arbor Research Collaborative for Health, Ann Arbor, USA.Department of Basic Pathology, Universidade Federal do Paraná, Curitiba, Brazil. lia.nakao@ufpr.br.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35239175

Citation

Lima, Jordana D., et al. "High-volume Hemodiafiltration Decreases the Pre-dialysis Concentrations of Indoxyl Sulfate and P-cresyl Sulfate Compared to Hemodialysis: a Post-hoc Analysis From the HDFit Randomized Controlled Trial." Journal of Nephrology, vol. 35, no. 5, 2022, pp. 1449-1456.
Lima JD, Guedes M, Rodrigues SD, et al. High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: a post-hoc analysis from the HDFit randomized controlled trial. J Nephrol. 2022;35(5):1449-1456.
Lima, J. D., Guedes, M., Rodrigues, S. D., Flórido, A. C. S., Moreno-Amaral, A. N., Barra, A. B., Canziani, M. E., Cuvello-Neto, A., Poli-de-Figueiredo, C. E., Pecoits-Filho, R., & Nakao, L. S. (2022). High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: a post-hoc analysis from the HDFit randomized controlled trial. Journal of Nephrology, 35(5), 1449-1456. https://doi.org/10.1007/s40620-022-01283-3
Lima JD, et al. High-volume Hemodiafiltration Decreases the Pre-dialysis Concentrations of Indoxyl Sulfate and P-cresyl Sulfate Compared to Hemodialysis: a Post-hoc Analysis From the HDFit Randomized Controlled Trial. J Nephrol. 2022;35(5):1449-1456. PubMed PMID: 35239175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: a post-hoc analysis from the HDFit randomized controlled trial. AU - Lima,Jordana D, AU - Guedes,Murilo, AU - Rodrigues,Silvia D, AU - Flórido,Ana Clara S, AU - Moreno-Amaral,Andrea N, AU - Barra,Ana Beatriz, AU - Canziani,Maria Eugênia, AU - Cuvello-Neto,Américo, AU - Poli-de-Figueiredo,Carlos Eduardo, AU - Pecoits-Filho,Roberto, AU - Nakao,Lia S, Y1 - 2022/03/03/ PY - 2021/12/06/received PY - 2022/02/08/accepted PY - 2022/3/4/pubmed PY - 2022/6/25/medline PY - 2022/3/3/entrez KW - Convective volume KW - Hemodiafiltration KW - Post-hoc analysis KW - Protein-bound uremic toxins SP - 1449 EP - 1456 JF - Journal of nephrology JO - J Nephrol VL - 35 IS - 5 N2 - BACKGROUND: Although high-volume online hemodiafiltration has been associated with higher clearance and lower pre-dialysis concentration of middle molecular weight toxins compared to hemodialysis, its effect on protein-bound uremic toxins has shown inconclusive results. In this study, we investigated whether hemodiafiltration impacts pre-dialysis plasma levels of the toxins indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid compared to high-flux hemodialysis. METHODS: This is a post-hoc analysis of the multicenter, randomized controlled trial HDFit (ClinicalTrials.gov: NCT02787161). Uremic toxins were determined by high performance liquid chromatography at baseline, 3, and 6 months. Mean differences in monthly changes of pre-dialysis uremic toxin concentrations between hemodiafiltration and high-flux hemodialysis were analyzed using linear mixed-effect models. RESULTS: One hundred ninety-three patients (mean age 53 years old, 71% males) were analyzed. There were no differences between groups regarding clinical and biochemical characteristics at baseline or duration of dialysis session and blood flows throughout the follow-up. Mean differences in rates of change (μM/month, [confidence interval CI]) in high-flux hemodialysis vs. hemodiafiltration were 2.4 [0.3 to 4.56], 3.94 [- 1.54 to 9.41] and 0.06 [- 0.6 to 0.5] for indoxyl sulfate, p-cresyl sulfate and indole-3-acetic acid, respectively. In the exploratory analysis, these differences in high-flux hemodialysis vs. hemodiafiltration subgroup with convective volume > 27.5 L were 2.86 [0.43 to 5.28], 7.43 [0.7 to 14.16] and - 0.19 [- 0.88 to 0.50]. CONCLUSION: These exploratory findings suggest that hemodiafiltration is more effective in reducing indoxyl sulfate as compared to standard high-flux hemodialysis, and also that this effect was extended to p-cresyl sulfate in patients achieving higher convective volumes. SN - 1724-6059 UR - https://www.unboundmedicine.com/medline/citation/35239175/High_volume_hemodiafiltration_decreases_the_pre_dialysis_concentrations_of_indoxyl_sulfate_and_p_cresyl_sulfate_compared_to_hemodialysis:_a_post_hoc_analysis_from_the_HDFit_randomized_controlled_trial_ L2 - https://dx.doi.org/10.1007/s40620-022-01283-3 DB - PRIME DP - Unbound Medicine ER -