Intradialytic cardiovascular injury is lowest in high-volume haemodiafiltration: a randomized cross-over trial in four intermittent dialysis strategies
Clinical Kidney Journal(2024)
Abstract
Abstract Background Intradialytic hypotension (IDH) and subsequent tissue damage may contribute to the poor outcome of chronic haemodialysis (HD) patients. Whilst the IDH-incidence is lower in high-volume haemodiafiltration (HV-HDF) than in standard HD (S-HD), survival is better in HV-HDF. Tissue injury, as measured by extracellular vesicle (EV)-release, was compared between four modalities. Methods Forty chronic patients were cross-over randomized to S-HD, cool-HD (C-HD), low-volume HDF (LV-HDF) and HV-HDF. Blood pressure was recorded every 15′. EVs from circulating blood-cell-elements (bio-incompatibility [BI]-related) and cardiovascular (CV) tissues (CV-related), were measured before and after dialysis. The influence of modalities and IDH on the rate-of-change of EVs was assessed. Both crude and haemoconcentration-adjusted analyses were performed. Results Leukocyte and erythrocyte-derived EVs increased in all modalities. Platelet-derived EVs increased more in LV-HDF and HV-HDF (68.4 resp. 56.1 × 106/mL) than in S-HD (27.5 × 106/mL), p for interaction < 0.01 resp. 0.06. Endothelial-derived CD144+ (2.3 × 106/mL in HV-HDF and 9.8 × 106/mL in S-HD) and cardiomyocyte-derived Connexin-43+ (12.0 resp. 31.9 × 106/mL) EVs increased less in HV-HDF than in S-HD (p for interaction 0.03 resp. 0.06). Correction for haemoconcentration attenuated all changes, although the increase in platelet-derived EVs remained significant in LV-HDF and HV-HDF, and CD144+ and Connexin-43+ EVs increased most in S-HD. EV-release was similar in patients with varying IDH-susceptibility and in sessions with and without IDH. Conclusions Most EVs increase during HD and HDF. Regarding platelet-derived EVs, HDF appears less biocompatible than HD. Considering CV-related EVs, tissue injury seems less pronounced in HV-HDF. The finding that EV-release is IDH-independent needs confirmation.
MoreTranslated text
AI Read Science
Must-Reading Tree
Example
![](https://originalfileserver.aminer.cn/sys/aminer/pubs/mrt_preview.jpeg)
Generate MRT to find the research sequence of this paper
Chat Paper
Summary is being generated by the instructions you defined