A single dialysis session of hemodiafiltration with sorbent-regenerated endogenous ultrafiltrate reinfusion (HFR) removes hepcidin more efficiently than bicarbonate hemodialysis: a new approach to containing hepcidin burden in dialysis patients?

• Published in: Journal of nephrology 2018-04, Vol.31 (2), p.297-306
• Main Authors: Tessitore, Nicola, Poli, Albino, Bedogna, Valeria, Corazza, Luca, Campostrini, Natascia, Atti, Mauro, Sereni, Luisa, Castagna, Annalisa, Girelli, Domenico, Pessolano, Giuseppina, Lupo, Antonio
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Nephrology; Original Article; Urology
• ISSN: 1121-8428; 1724-6059
• DOI: 10.1007/s40620-017-0383-0

Background Most hemodialysis patients have high Hepcidin-25 levels, which may be involved in the pathogenesis of several uremic complications related to an altered iron biology. The hemodialysis procedure itself can influence Hepcidin-25 levels by removing Hepcidin-25 and maybe stimulating its production due to a pro-inflammatory effect. Methods To assess the relationship between dialysis-related inflammation and intradialysis changes in Hepcidin-25, we performed a crossover trial in 28 hemodialysis patients to compare the effects on serum levels of Hepcidin-25 and inflammatory markers activated during dialysis [Tumor Necrosis Factor-α (TNF-α), Interleukin-6, C-reactive protein (CRP), Pentraxin-3] of a single dialysis session using a technique capable of reducing inflammation, HFR (Hemo Filtrate Reinfusion: a hemodiafiltration system combining convection, diffusion and adsorption) or bicarbonate-dialysis using either the same low-flux membrane as in the diffusion stage of HFR (LFBD) or a high-flux membrane (HFBD). Results HFR achieved a greater reduction in Hepcidin-25 levels than both LFBD [−72% (95% CI: −11 to −133), p = 0.022] and HFBD [−137% (95% CI: −2 to −272), p = 0.047], conceivably due to both a greater removal (because of its convective/adsorptive component) and a lower inflammation-related Hepcidin-25 production. HFR also led to a greater decrease in TNF-α than LFBD [−277% (95% CI: −59 to −494), p = 0.014], while the two methods induced similar changes in Interleukin-6, CRP and Pentraxin-3 levels. Conclusions Our findings suggest that a single bicarbonate-dialysis session can upregulate Hepcidin-25 synthesis and that HFR can fully overcome this effect, enabling a greater Hepcidin-25 removal during dialysis. Adequately-designed studies are needed, however, to establish whether the beneficial effect of HFR emerging from our study could reduce Hepcidin-25 (and TNF-α) burden and improve clinically-relevant outcomes. Trial registration: ISRCTN15957905