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      Hemodiafiltration Improves Plasma 25-Hepcidin Levels: A Prospective, Randomized, Blinded, Cross-Over Study Comparing Hemodialysis and Hemodiafiltration

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          Abstract

          Background/Aims: Data from studies comparing the effect of hemodiafiltration (HDF) and conventional hemodialysis (HD) on clinically important outcomes are insufficient to support superiority of HDF. None of these studies has been participant-blinded. Methods: We performed a prospective, randomized, and patient-blinded cross-over study. Twenty patients on chronic HD received either HD for 2 months followed by post-dilution HDF for 2 months or in opposite order. A range of clinical parameters, as well as markers of inflammation, oxidative stress and iron metabolism was measured. Results: The two treatments were similar with respect to dialysis-related complications, quality of life, and the biomarkers of oxidative stress and inflammation. Compared to HD, 25-hepcidin and β<sub>2</sub>-microglobulin were 38 and 32%, respectively, lower after 60 days of HDF (p < 0.001 and p < 0.01, respectively). The consumption of ESA (erythropoietin-stimulating agent) and LMWH (low-molecular-weight heparin) was significantly higher with HDF. Conclusion: In short term, HDF is not superior to HD regarding dialysis-related complications. The higher ESA consumption observed with HDF can be explained by blood clotting in tubing and dialyzers, as more anticoagulation was needed with post-dilution HDF. In a longer perspective, lowering serum hepcidin levels may improve pathological iron homeostasis.

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          Most cited references51

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          IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin.

          Hypoferremia is a common response to systemic infections or generalized inflammatory disorders. In mouse models, the development of hypoferremia during inflammation requires hepcidin, an iron regulatory peptide hormone produced in the liver, but the inflammatory signals that regulate hepcidin are largely unknown. Our studies in human liver cell cultures, mice, and human volunteers indicate that IL-6 is the necessary and sufficient cytokine for the induction of hepcidin during inflammation and that the IL-6-hepcidin axis is responsible for the hypoferremia of inflammation.
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            Oxidative damage to proteins: spectrophotometric method for carbonyl assay.

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              [38] Oxidative damage to proteins: Spectrophotometric method for carbonyl assay

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                Author and article information

                Journal
                NNE
                NNE
                10.1159/issn.1664-5529
                Nephron Extra
                S. Karger AG
                1664-5529
                2012
                January – December 2012
                28 March 2012
                : 2
                : 1
                : 55-65
                Affiliations
                Departments of Molecular and Clinical Medicine and Nephrology, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
                Author notes
                *Bergur V. Stefánsson, MD, Department of Nephrology, The Renal Research Centre, University of Gothenburg, Box 432, SE–405 30 Gothenburg (Sweden), Tel. +46 31 342 1000, E-Mail bergur.stefansson@wlab.gu.se
                Article
                336482 PMC3350355 Nephron Extra 2012;2:55–65
                10.1159/000336482
                PMC3350355
                22619668
                e16d8a85-f05d-445d-a4f8-a36ae2cb5b88
                © 2012 S. Karger AG, Basel

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 1, Tables: 4, Pages: 11
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                Hepcidin,Inflammation,Quality of life,Anticoagulation,Erythropoiesis,β2-Microglobulin,Hemodiafiltration,Hemodialysis

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