Journal Article

Dialysis filter type determines the acute effect of haemodialysis on endothelial function and oxidative stress

Markus Kosch, Andrea Levers, Manfred Fobker, Michael Barenbrock, Roland M. Schaefer, Karl‐Heinz Rahn and Martin Hausberg

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue 7, pages 1370-1375
Published in print July 2003 | ISSN: 0931-0509
Published online July 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg169
Dialysis filter type determines the acute effect of haemodialysis on endothelial function and oxidative stress

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Background. Endothelial function of large arteries is impaired in chronic haemodialysis patients and oxidative stress due to the dialysis procedure has been suggested as a causal factor. However, it is not clear whether different types of dialysis membranes affect endothelial function differently. Therefore we determined endothelium‐dependent, flow‐mediated dilatation (FMD) of the brachial artery as well as markers of oxidative stress immediately before and after haemodialysis (HD) with either a cellulosic cuprophane or a synthetic polysulphone dialyser in a blinded, randomized, cross‐over study.

Methods. Twelve haemodialysis patients (age 55±3 years, time on dialysis 20±2 months, mean fluid change −1782±21 ml, systolic/diastolic blood pressure 139/75 mmHg) were included. Using a multi‐gate‐pulsed Doppler system (echo‐tracking device) brachial artery FMD and nitroglycerine‐induced, endothelium‐independent vasodilatation (NMD) were measured. Patients were randomized to HD with either a polysulphone or a cuprophane membrane and were crossed over to the other filter. Investigators were blinded to the type of membrane used. Serum concentrations of oxidized LDL (oxLDL) and α‐tocopherol as markers of oxidative stress were measured before and after each dialysis session.

Results. Data are given as mean±SEM. Treatment with polysulphone filter HD did not significantly affect FMD (baseline 9.3±2.0% vs after HD 9.6±1.8%). After dialysis with a cuprophane membrane FMD decreased from 9.4±2.1 to 7.4±1.8% (P<0.05). NMD was not significantly affected by HD irrespective of the membrane material used. Serum levels of oxLDL were not changed by either treatment; however, α‐tocopherol concentrations fell significantly after dialysis with the cuprophane filter (baseline 18.0±2.3 after HD 16.6±1.3 µg/ml, P<0.05), while α‐tocopherol levels remained unchanged when the polysulphone membrane was used.

Conclusions. The type of dialysis filter membrane determines the acute effect of haemodialysis on arterial endothelial function. Differences in biocompatibility and oxidative stress may account for the observed differential effects, since the decrease of FMD after dialysis with a cellulosic cuprophane membrane—but not with a synthetic polysulphone membrane—was associated with a reduction in serum vitamin E.

Keywords: cuprophane; endothelial function; flow‐mediated vasodilatation; haemodialysis; oxidative stress; polysulphone

Journal Article.  3453 words.  Illustrated.

Subjects: Nephrology

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