Conversion from hemodialysis to hemodiafiltration affects innate immunity of individuals with chronic kidney disease

Abstract

Abstract Background: Once a diagnosis of chronic kidney disease (CKD) phase 5 is confirmed, possible treatments include renal replacement therapies, such as haemodialysis (HD) and haemodiafiltration (HDF). HD removes low-molecular-weight molecules, while HDF purges small and large molecules, favouring the reduction of oxidative stress. This study evaluated the haematological, biochemical and immunological parameters of individuals with CKD treated with HD who later converted to HDF. Methods: This is a descriptive and comparative study carried out with 25 individuals (66±10 years) treated with HD who later converted to HDF (convenience sample). Data were analysed in blood samples (cells and serum). Results: The aetiologies of RCD were type II DM (48%) and SAH (32%). Before conversion to HDF, the time spent on HD was 4.7±4.9 years. There was a negative correlation between HD time and age. Cells and serum markers: HDF reduced serum levels of erythropoietin (EPO), glucose, aspartate aminotransferase, and ꞵ2-microglobulin and the EPO resistance index and increased levels of alkaline phosphatase and C-reactive protein. Immunological markers: HDF normalized the phagocytic index with 5 or 20 yeasts/cell and normalized the stimulated corpuscular index but increased TNF and IL-4 production compared to HD. Furthermore, HDF normalized the basal production of O2●- and its production in the absence of phagocytosis, but when compared to HD, HDF increased the production of O2●- in the presence or absence of yeast ingestion. Conclusions: Our results indicate that HDF is efficient in treating patients with CKD. Considering that HDF is rarely used in Brazil, a study is suggested to promote greater visibility and acceptance of HDF in patients and the medical community, aiming at its future implementation in the public health system. Clinical trial registration: Study approved by the Research Ethics Committee of the Faculty of Medicine of the University of Brasilia nº 16921313.5.0000.0030.