Derosa Giuseppe, Libetta Carmelo, Esposito Pasquale, Borettaz Ilaria, Tinelli Carmine, D'angelo Angela, Maffioli Pamela
Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Centre for Prevention, Surveillance, Diagnosis and Treatment of Rare Diseases, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Centre for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy; Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy.
Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
Cytokine. 2017 Apr;92:75-79. doi: 10.1016/j.cyto.2016.12.026. Epub 2017 Jan 18.
This study was aimed to evaluate the effects on some inflammatory markers of two dialytic treatments [bicarbonate dialysis (BHD) and hemodiafiltration (HDF)] in patients with severe chronic kidney disease. We evaluated: blood glucose, homeostasis model assessment insulin resistance index, homocistein (Hcs), high sensitivity C-reactive protein (hs-CRP), fibrinogen, lipoprotein (a) [Lp(a)], metalloproteinases-2, and -9 (MMP-2 and MMP-9), and soluble receptor for advanced glycation end products (sRAGE). Considering the all sample, we observed a decrease of sRAGE with BHD, but not with HDF. Fibrinogen, MMP-2, and -9, Hs-CRP decreased after HDF, but not after BHD. In diabetics, blood glucose decreased after HDF dialysis, but not after BHD. Soluble receptor for advanced glycation end products obtained with HDF were higher compared to BHD. Fibrinogen, MMP-2, MMP-9, Hcs, Hs-CRP decreased, and ADN increased after HDF, these changes did not happen after BHD. Furthermore, sRAGE, and ADN were higher, and MMP-2 lower after HDF. In euglycemic patients, instead, MMP-2, MMP-9, and Hs-CRP decreased, and ADN increased with HDF, but not with BHD. We can conclude that hemodiafiltration seems to greater reduce inflammatory markers, and it could be more suitable for people with type 2 diabetes. Registration number: ClinicalTrials.gov NCT01049152.
本研究旨在评估两种透析治疗方法[碳酸氢盐透析（BHD）和血液透析滤过（HDF）]对重症慢性肾病患者某些炎症标志物的影响。我们评估了：血糖、稳态模型评估胰岛素抵抗指数、同型半胱氨酸（Hcs）、高敏C反应蛋白（hs-CRP）、纤维蛋白原、脂蛋白（a）[Lp（a）]、金属蛋白酶-2和-9（MMP-2和MMP-9）以及晚期糖基化终末产物可溶性受体（sRAGE）。考虑到所有样本，我们观察到BHD组sRAGE降低，而HDF组未降低。HDF后纤维蛋白原、MMP-2和-9、Hs-CRP降低，而BHD后未降低。在糖尿病患者中，HDF透析后血糖降低，而BHD后未降低。HDF获得的晚期糖基化终末产物可溶性受体高于BHD。HDF后纤维蛋白原、MMP-2、MMP-9、Hcs、Hs-CRP降低，ADN升高，BHD后未出现这些变化。此外，HDF后sRAGE和ADN更高，MMP-2更低。在血糖正常的患者中，相反，HDF后MMP-2、MMP-9和Hs-CRP降低，ADN升高，而BHD后未出现这种情况。我们可以得出结论，血液透析滤过似乎能更大程度地降低炎症标志物，可能更适合2型糖尿病患者。注册号：ClinicalTrials.gov NCT01049152。
