Abstract
BackgroundIncreasing the blood flow rate (BFR) is a useful method for increasing Kt/V and the clearance for low molecular solutes. Hemodialysis patients are often anemic due to hypoerythropoiesis and their chronic inflammatory state. Hepcidin, a hormone that regulates iron homeostasis, is considered as an indicator of iron deficiency in patients with end-stage renal disease. This study aimed to investigate the effects of an increased BFR during hemodialysis on serum hepcidin levels and anemia.MethodsBetween April 2014 and March 2016, 22 chronic dialysis patients (11 men [50.0 %]; mean [± standard deviation] age, 72 ± 12 years) undergoing maintenance hemodialysis treatment, thrice weekly, were enrolled and followed prospectively for 24 months. In April 2014, the BFR was 200 mL/min; in April 2015 this was increased to 400 mL/min, which was within acceptable limits. The dialysate flow rate remained stable at; 500mlL/min. Blood samples were collected in March 2015 and 2016. The primary endpoint was the comparison of the amounts of erythropoiesis-stimulating agent (ESA) required.ResultsThe increased BFR increased the Kt/V and contributed to significantly decreased urea nitrogen (UN) (p = 0.015) and creatinine (Cr) (p = 0.005) levels. The dialysis efficiency was improved by increasing the BFR. Ferritin (p = 0.038), hepcidin (p = 0.041) and high-sensitivity interleukin-6 (p = 0.038) levels were also significantly reduced. The ESA administered was significantly reduced (p = 0.004) and the Erythropoietin Resistant Index (ERI) significantly improved (p = 0.031). The reduction rates in UN (p < 0.001), Cr (p < 0.001), and beta-2 microglobulin (p = 0.017) levels were significantly greater post the BFR increase compared to those prior to the BFR increase. However, hepcidin was not affected by the BFR change.ConclusionsIncreasing BFR was associated with hemodialysis efficiency, and led to reduce inflammatory cytokine interleukin-6, but did not contribute to reduce C-reactive protein. This reduced hepcidin levels, ESA dosage and ERI. Hepcidin levels were significantly correlated with ferritin levels, and it remains to be seen whether reducing hepcidin leads to improve ESA and iron availability during anemia management.
Highlights
Increasing the blood flow rate (BFR) is a useful method for increasing Kt/V and the clearance for low molecular solutes
After increasing the BFR without changing the treatment time, Kt/V was significantly higher in post the BFR increase, but there was no significant difference in dry weight
There were no significant differences in Red blood cell (RBC), Hb, Hct, albumin, and total cholesterol levels pre and post the BFR increase
Summary
Increasing the blood flow rate (BFR) is a useful method for increasing Kt/V and the clearance for low molecular solutes. A hormone that regulates iron homeostasis, is considered as an indicator of iron deficiency in patients with end-stage renal disease. Appropriate dialysis management is essential in reducing morbidity and mortality among patients on maintenance hemodialysis (HD) [1]. For patients with end-stage renal disease (ESRD), long-term HD can place a significant burden on quality and duration of life [2]. A previous study reported increased urea clearance with increased BFR when the dialysis machine, dialysis membrane, and dialysate flow rate remained constant [5]. There have been few studies on the relationship between BFR and morbidity and mortality in HD patients; the optimal BFR remains unclear
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
