单次使用吸附剂再生内源性超滤液回输的血液透析滤过（HFR）清除铁调素的效率高于碳酸氢盐血液透析：这是一种控制透析患者铁调素负担的新方法吗？

A single dialysis session of hemodiafiltration with sorbent-regenerated endogenous ultrafiltrate reinfusion (HFR) removes hepcidin more efficiently than bicarbonate hemodialysis: a new approach to containing hepcidin burden in dialysis patients?

机构信息

Emodialisi Borgo Roma, Nephrology Section, Department of Medicine, University of Verona, Piazzale LA Scuro 10, 37134, Verona, Italy.

Department of Diagnostic and Public Health, University of Verona, Verona, Italy.

出版信息

J Nephrol. 2018 Apr;31(2):297-306. doi: 10.1007/s40620-017-0383-0. Epub 2017 Mar 28.

DOI:10.1007/s40620-017-0383-0

PMID:28353202

Abstract

BACKGROUND

Most hemodialysis patients have high Hepcidin-25 levels, which may be involved in the pathogenesis of several uremic complications related to an altered iron biology. The hemodialysis procedure itself can influence Hepcidin-25 levels by removing Hepcidin-25 and maybe stimulating its production due to a pro-inflammatory effect.

METHODS

To assess the relationship between dialysis-related inflammation and intradialysis changes in Hepcidin-25, we performed a crossover trial in 28 hemodialysis patients to compare the effects on serum levels of Hepcidin-25 and inflammatory markers activated during dialysis [Tumor Necrosis Factor-α (TNF-α), Interleukin-6, C-reactive protein (CRP), Pentraxin-3] of a single dialysis session using a technique capable of reducing inflammation, HFR (Hemo Filtrate Reinfusion: a hemodiafiltration system combining convection, diffusion and adsorption) or bicarbonate-dialysis using either the same low-flux membrane as in the diffusion stage of HFR (LFBD) or a high-flux membrane (HFBD).

RESULTS

HFR achieved a greater reduction in Hepcidin-25 levels than both LFBD [-72% (95% CI: -11 to -133), p = 0.022] and HFBD [-137% (95% CI: -2 to -272), p = 0.047], conceivably due to both a greater removal (because of its convective/adsorptive component) and a lower inflammation-related Hepcidin-25 production. HFR also led to a greater decrease in TNF-α than LFBD [-277% (95% CI: -59 to -494), p = 0.014], while the two methods induced similar changes in Interleukin-6, CRP and Pentraxin-3 levels.

CONCLUSIONS

Our findings suggest that a single bicarbonate-dialysis session can upregulate Hepcidin-25 synthesis and that HFR can fully overcome this effect, enabling a greater Hepcidin-25 removal during dialysis. Adequately-designed studies are needed, however, to establish whether the beneficial effect of HFR emerging from our study could reduce Hepcidin-25 (and TNF-α) burden and improve clinically-relevant outcomes.

TRIAL REGISTRATION

ISRCTN15957905.

摘要

背景

大多数血液透析患者的 Hepcidin-25 水平较高，这可能与多种与铁生物学改变相关的尿毒症并发症的发病机制有关。血液透析过程本身可以通过去除 Hepcidin-25 并由于炎症反应而可能刺激其产生来影响 Hepcidin-25 水平。

方法

为了评估与透析相关的炎症与 Hepcidin-25 透析过程中变化之间的关系，我们在 28 名血液透析患者中进行了一项交叉试验，比较了使用能够减少炎症的技术（HFR，血液滤过再灌注：一种结合对流、扩散和吸附的血液透析滤过系统）或碳酸氢盐透析（LFBD，低通量膜扩散阶段的相同膜或 HFBD，高通量膜）进行单次透析时，Hepcidin-25 水平和炎症标志物（肿瘤坏死因子-α（TNF-α）、白细胞介素-6、C 反应蛋白（CRP）、五聚素-3）的血清水平的变化。

结果

HFR 比 LFBD（-72%（95%CI：-11 至-133），p=0.022）和 HFBD（-137%（95%CI：-2 至-272），p=0.047）更能降低 Hepcidin-25 水平，这可能是由于其对流/吸附成分的去除作用更大，以及炎症相关 Hepcidin-25 产生的降低。HFR 还导致 TNF-α水平下降比 LFBD 更大[-277%（95%CI：-59 至-494），p=0.014]，而两种方法诱导的白细胞介素-6、CRP 和五聚素-3 水平的变化相似。

结论

我们的研究结果表明，单次碳酸氢盐透析可上调 Hepcidin-25 合成，而 HFR 可完全克服这一效应，使透析过程中 Hepcidin-25 的清除率增加。然而，需要进行设计合理的研究，以确定我们研究中 HFR 带来的有益效果是否可以降低 Hepcidin-25（和 TNF-α）负担并改善临床相关结局。