Effect of hemodiafiltration (HDF) therapy on inflammation, endothelial injury and mineral bone disease in patients with chronic kidney disease

Abstract

The prevalence of chronic kidney disease (CKD) ranges from 1.7% to 8.1%, with an estimated prevalence of 5.6% in the general population, and it has a major impact on public health in the elderly, affecting up to 11% of the population. Hemodialysis (HD) is a technique usually performed by about 90% of patients. However, this has adverse effects such as: large fluctuations in weight, osmolality, urea concentration, electrolytes and does not remove all toxic substances (uremic toxins); especially those with middle molecular weight or proteins bound. The accumulation of uremic toxins in HD patients has been associated with increase in inflammation, malnutrition, loss of muscle mass, poorer quality of life, bone mineral disease, cardiovascular disease (CVD) and mortality 20 times higher (CVD) compared to the general population paired by traditional risk factors such as age, sex, presence of diabetes, hypertension, obesity and smoking. Inflammation is one of the main pathophysiological mechanisms of CVD, bone disease and loss of muscle mass in the population with CKD in dialysis, mainly in HD. The HD does not clearance middle or large molecular weight uremic toxins, which are responsible to induce inflammatory cytokines and oxidative stress that contribute to destruction of the endothelial layer, vascular injury, muscle, osteocytes, and osteoclasts cell injury; resulting in elevated rate of morbidity and mortality in these patients. Recently, hemodialfiltration (HDF) has been described as a dialytic modality that promotes greater clearance of uremic toxins, such as ²2-microglobulin; suggesting that HDF could reduce adverse effects and mortality in this population compared to HD treatment. However, although it has been reported that HDF is a modality that improves volume fluctuations, osmolality, urea concentration, electrolytes and removal of uremic toxins; there are few studies evaluating the effect of HDF on inflammatory, endothelial and bone mineral metabolism in the same study. In this way, investigating new treatment approaches, such as HDF can have beneficial effects on inflammation and perhaps consequently less loss of muscle mass, endothelial lesion and bone mineral disorder; which may contribute to lower mortality in the CKD population. (AU)