Efeito da Hemodiafiltração (HDF) sobre biomarcadores de massa muscular e nutricionais em pacientes idosos com doença renal crônica

Abstract

Introduction: Chronic kidney disease (CKD) is now recognized as a public health. The presence of uremic toxins that are not fully dialyzed by HD induces greater synthesis of inflammatory cytokines and oxidative stress, which contribute to muscle catabolism, leading to loss of muscle mass. The loss of muscle mass in this population has been associated with greater morbidity and mortality. Hemodiafiltration (HDF) has been described as a dialysis modality that promotes greater clearance of uremic toxins. Thus, the aim of this study was to evaluate the effect of HDF on uremic toxins, inflammatory mechanism and its impact on muscle mass in elderly patients with CKD incident on HDF. Methods: Thirty-one elderly patients ≥65 years old who were undergoing HD treatment and were transferred to HDF, evaluated at baseline and 6 months after HDF, were selected for convenience. We evaluated: C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), serum muscle mass markers: myostatin and irisin, by ELISA, and the uremic toxins indoxyl sulfate (IS), p-cresyl sulfate (PCS) and indole acetic acid (IAA) by high-performance chromatography (HPLC). Results: Six months after starting HDF, we observed a significant reduction in serum IS levels (p < 0.01). We did not observe significant differences in serum concentrations of IL-6, IL-10, TNF-α, CRP, myostatin and irisin after 6 months of HDF. Conclusion: This was the first study to show that after 6 months of HDF there was a reduction in the serum concentration of IS in elderly patients with CKD. However, this result had no influence on inflammation and muscle mass biomarkers. The impact of this finding in the medium and long term must be evaluated in a future study.