Acute Effects of Online Hemodiafiltration versus High Flux Hemodialysis on Serum Levels of Asymmetric Dimethylarginine (ADMA), and Tumor Necrosis Factor (TNF)-Alpha

Abstract

Abstract Background In ESRD patients, chronic inflammation is a common feature and results in cardiovascular morbidity and mortality. Aim of the Work to identify a superior merit for convective dialysis over high flux dialysis in decreasing the serum level of tumour necrosis factor alpha (TNF α) and Asymmetric dimethylarginine (ADMA) in ESRD adult population. Patients and Methods This study was conducted on 20 patients from the ESRD patients attending the dialysis unit of nephrology department in Ain Shams specialized hospital, the selected subjects were being treated by dialytic support in the form of two sessions of high flux standard haemodialysis and one session of hemodiafiltration each week. All the selected patients were clinically stable, aged ≥18 years, receiving dialysis for≥ 3 months, with wellfunctioning AV fistulas, not on anti-inflammatory or immunosuppressive drugs for 3 months earlier and during the study. Results there was a highly statistically significant increase in Percent of change (drop) in TNFα post HDF session versus high flux HD session. Similarly, the Percent of change (drop) in ADMA was higher post HDF session versus high flux HD session which represented a highly statistically significant difference. The results of our study showed superiority of HDF over HF HD in TNF α and ADMA clearance. Conclusion Convective clearance plays a crucial role in improving the biomarker profile. Using online hemodiafiltration technique that combines the use of high-flux synthetic membrane with low bio reactive profile and the use of ultrapure dialysis fluid showed a significant reduction of ADMA and TNF alpha in adult with ESRD.