Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica

Abstract

Introduction: Chronic kidney disease (CKD) is a public health problem, with a worldwide prevalence of 9.1%. In Brazil, hemodialysis (HD) is generally performed by about 90% of patients with CKD. However, this dialysis modality does not remove toxic substances (uremic toxins) with medium molecular weight or linked to proteins. The accumulation of uremic toxins in HD patients has been associated with increased inflammation, poor quality of life, bone mineral disease (BMD) and cardiovascular disease (CVD). Inflammation is one of the main pathophysiological mechanisms of CVD and BMD in the population with CKD undergoing dialysis, especially on HD. Recently, hemodiafiltration (HDF) has been described as a dialysis modality that can promote greater clearance of medium molecular weight or protein-bound uremic toxins; suggesting that HDF could reduce the adverse effects of inflammation, BMD, and CVD. However, although HDF has been reported to be a modality that improves the removal of uremic toxins, there are few studies evaluating the effect of HDF in the removal of protein-bound uremic toxins (indoxyl sulfate (IS), p-Cresylsulfate (PCS) and indole acetic acid (IAA) and its impact on inflammatory, endothelial and bone mineral metabolism mechanisms in the elderly population. Objective: to evaluate the effects of HDF on the serum concentration of uremic toxins, biomarkers of inflammation, endothelial and bone mineral disorder, in elderly patients with CKD. Methods: Thirty-one elderly patients ≥65 years old who started dialysis for HDF were selected for convenience. We evaluated at baseline and after 6 months: urea, creatinine, sodium, potassium, glucose, albumin, C-reactive protein (CRP), calcium, phosphorus, parathormone (PTH), 25 hydroxy vitamin D (25(OH)D and beta-2 microglobulin (B2M), by automated methods using commercial kits. interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), fibroblast growth factor 23 (FGF-23), sclerostin (SOST) and osteopontin (OPN) by enzyme-linked immunosorbent assay (ELISA) using commercial kits. IS, PCS and IAA by high-performance liquid chromatography (HPLC) Results: After 6 months of treatment with HDF, we observed that the patients showed significant reduction in serum concentration of IS levels (p <0.01) and significant increase in serum concentrations of B2M, urea, creatinine, and calcium. We did not observe significant differences between the other variables. Conclusion: this study showed that HDF reduced serum levels of the uremic toxin indoxyl sulfate in the elderly population. The impact of this reduction in the elderly population on clinical outcomes must be evaluated in future studies.