Gabriele Donati1, Andrea Angeletti2, Maria Cappuccilli2, Chiara Donadei2, Chiara Guglielmo2, Anna Scrivo2, Lorenzo Gasperoni3, Maddalena Zambelli2, Maria Mattiotti2, Gaetano La Manna4. 1. Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliero-Universitaria di Modena, Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy. 2. Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy. 3. Nephrology and Dialysis Unit, Infermi Hospital, Rimini, Italy. 4. Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy; gaetano.lamanna@unibo.it.
Abstract
BACKGROUND/AIM: Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate (Supra-HFR) is a dialysis technique used to improve uremic toxin removal in the range of the middle molecular weight molecules. Supra-HFR does not require the preparation and online infusion of high-purity dialysis water because it allows the production of an endogenous ultrafiltrate that undergoes detoxification through an adsorbing resin. PATIENTS AND METHODS: We investigated the ability of Supra-HFR to remove fibroblast growth factor 23 (FGF23), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), interleukin 8 (IL-8), and transforming growth factor alpha (TGF-alpha) after a single session dialysis in nine patients affected by end stage renal disease (ESRD). The same patients underwent a single session of online hemodiafiltration (OL-HDF) to evaluate possible differences in FGF23 and IL-6 levels. RESULTS: A significant reduction in FGF23 was observed with both Supra-HFR (p=0.001) and OL-HDF. As for TNF-alpha and TGF-alpha, which were measured using Supra-HFR only, their percentage values were significantly lower at the end of dialysis than at the start (p=0.0028 and p=0.03, respectively). This did not change with post-dialysis rebound. Supra-HFR was found to have no effect on IL-6 and IL-8. Interestingly, the removal rate for FGF23 and IL-6 was similar to that observed with OL-HDF. CONCLUSION: Supra-HFR was not superior to OL-HDF, with suboptimal convective volume in the removal of the molecules tested, especially FGF23, which is considered a large middle molecular weight uremic toxin.
BACKGROUND/AIM: Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate (Supra-HFR) is a dialysis technique used to improve uremic toxin removal in the range of the middle molecular weight molecules. Supra-HFR does not require the preparation and online infusion of high-purity dialysis water because it allows the production of an endogenous ultrafiltrate that undergoes detoxification through an adsorbing resin. PATIENTS AND METHODS: We investigated the ability of Supra-HFR to remove fibroblast growth factor 23 (FGF23), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), interleukin 8 (IL-8), and transforming growth factor alpha (TGF-alpha) after a single session dialysis in nine patients affected by end stage renal disease (ESRD). The same patients underwent a single session of online hemodiafiltration (OL-HDF) to evaluate possible differences in FGF23 and IL-6 levels. RESULTS: A significant reduction in FGF23 was observed with both Supra-HFR (p=0.001) and OL-HDF. As for TNF-alpha and TGF-alpha, which were measured using Supra-HFR only, their percentage values were significantly lower at the end of dialysis than at the start (p=0.0028 and p=0.03, respectively). This did not change with post-dialysis rebound. Supra-HFR was found to have no effect on IL-6 and IL-8. Interestingly, the removal rate for FGF23 and IL-6 was similar to that observed with OL-HDF. CONCLUSION: Supra-HFR was not superior to OL-HDF, with suboptimal convective volume in the removal of the molecules tested, especially FGF23, which is considered a large middle molecular weight uremic toxin.
Authors: C De Nitti; R Giordano; R Gervasio; G Castellano; V Podio; L Sereni; P M Ghezzi; C Ronco; A Brendolan; P Inguaggiato; M Tonelli; G La Greca; C Tetta Journal: Int J Artif Organs Date: 2001-11 Impact factor: 1.595
Authors: Elvira Esquivias-Motta; Alejandro Martín-Malo; Paula Buendia; Maria A Álvarez-Lara; Sagrario Soriano; Rodolfo Crespo; Julia Carracedo; Rafael Ramírez; Pedro Aljama Journal: Artif Organs Date: 2016-05-16 Impact factor: 3.094
Authors: G Cianciolo; G Donati; G La Manna; A Ferri; V Cuna; G Ubaldi; S Corsini; N Lanci; L Colì; S Stefoni Journal: Minerva Urol Nefrol Date: 2010-03 Impact factor: 3.720
Authors: Giuseppe Cianciolo; Gaetano La Manna; Elena Della Bella; Maria Laura Cappuccilli; Maria Laura Angelini; Ada Dormi; Irene Capelli; Claudio Laterza; Roberta Costa; Francesco Alviano; Gabriele Donati; Claudio Ronco; Sergio Stefoni Journal: Blood Purif Date: 2013-03-13 Impact factor: 2.614