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Titolo Long-term effects of high-efficiency on-line haemodiafiltration on uraemic toxicity. A multicentre prospective randomized study
Autore Luciano A. Pedrini1, Vincenzo De Cristofaro2, Mario Comelli3, Francesco G. Casino4, Mario Prencipe5, Adriana Baroni6, Gesualdo Campolo7, Celestina Manzoni8, Luigi Colı`9, Pio Ruggiero1, Irene Acquistapace2 and Laura Auriemma10 - 1Nephrology and Dialysis Units of Bolognini Hospital, Seriate, Italy, 2Hospital of Sondrio, Sondrio, Italy, 3Institute of Health Sciences, University of Pavia, Italy, 4Hospital of Matera, Italy, 5Cernusco Sul Naviglio, Milano, Italy, 6Verbania, Italy, 7Prato, Italy, 8Lecco, Italy, 9Policlinico S.Orsola-Malpighi, Bologna, Italy and 10Biochemistry Unit of Bolognini Hospital, Seriate, Italy
Referenza Nephrol Dial Transplant 2011; doi: 10.1093/ndt/gfq761
Contenuto Background. Haemodiafiltration (HDF) may improve survival of chronic dialysis patients. This prospective, multicentre randomized cross-over study evaluated the effects of long-term on-line HDF on the levels of solutes of different molecular weight markers or causative agents of the most common metabolic derangements in uraemia. Methods. Sixty-nine patients from eight Italian centres were randomly assigned to two 6-month treatment sequences: A-B and B-A [A, low-flux haemodialysis (HD) and B, on-line HDF]. Comparative evaluation of basal levels of small, medium-sized and protein-bound solutes at the end of the two treatment periods and analysis of parameters dependence during the interventions were performed. Results. On-line HDF showed greater efficiency than low-flux HD in removing small solutes (eKt/Vurea 1.60 6 0.31 versus 1.44 6 0.26, P < 0.0001) and in reducing basal levels of beta2-microglobulin (22.2 6 7.8 versus 33.5 6 11.8 mg/L, P < 0.0001), total homocysteine (15.4 6 5.0 versus 18.7 6 8.2 lmol/L, P ¼ 0 .003), phosphate (4.6 6 1.3 versus 5.0 6 1.4 mg/dL, P ¼ 0.008) and, remarkably, of intact parathyroid hormone (202 6 154 versus 228 6 176 pg/mL, P ¼ 0.03). Moreover, in on-line HDF, lower levels of C-reactive protein (5.5 6 5.5 versus 6.7 6 6.1 mg/L, P ¼ 0.03) and triglycerides (148 6 77 versus 167 6 87 mg/dL, P ¼ 0.008) and increased HDL cholesterol (49.2 6 12.7 versus 44.7 6 12.4 mg/dL, P ¼ <0.0001) were observed. The asymmetric dimethylarginine level was not significantly affected (0.97 6 0.4 versus 0.84 6 0.37 lmol/L). Erythropoietin and phosphate binders? doses could be reduced. Conclusions. On-line high-efficiency HDF resulted in enhanced removal and lower basal levels of small, mediumsized and protein-bound solutes, which are markers or causative agents of uraemic pathologies, mainly inflammation, secondary hyperparathyroidism and dyslipidaemia. This may contribute to reducing uraemic complications and possibly to improving patient survival.
Data 20.01.2011
 
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