Bicarbonate levels in hemodialysis patients switching from lanthanum carbonate to sucroferric oxyhydroxide.

AIM: To examine possible alterations in acid-base parameters in patients switching from lanthanum carbonate (LanC) to sucroferric oxyhydroxide (SFOH). METHODS: Fifteen stable hemodialysis patients were switched from LanC to SFOH. Only nine continued on SFOH, three returned to LanC and the other three switched to sevelamer carbonate. The later six patients served as a control group to the SFOH group of nine patients. Blood was sampled on the 3-d and the last 2-d interval of the week prior to switching and six weeks after. Bicarbonate levels (HCO3 -), pH, pO2, pCO2 were measured, and the mean of the two measurements (3-d and 2-d interval) was calculated. RESULTS: Comparing pre-switching to post-switching measurements in the SFOH group, no statistically significant differences were found in any of the parameters studied. The mean pre-switching HCO3 - was 22.41 ± 1.66 mmol/L and the mean post-switching was 22.62 ± 2.25 mmol/L (P = 0.889). Respectively, the mean pH= 7.38 ± 0.03 vs 7.39 ± 0.03 (P = 0.635), mean pCO2= 38.41 ± 3.29 vs 38.37 ± 3.62 mmHg (P = 0.767), and Phosphate = 1.57 ± 0.27 vs 1.36 ± 0.38mmol/L (P = 0.214). There were not any significant differences when we performed the same analyses in the control group or between the SFOH group and control group. No correlations were found, either between pre-switching LanC daily dose or between post-switching daily dose of the new binder and the measured parameters. CONCLUSION: In our small study, switching from LanC to SFOH did not have any significant effect on blood bicarbonate levels and gas analysis, indicating that there is no need to change hemodialysis prescription regarding these parameters.

Inflammation and oxidative stress in end-stage renal disease patients treated with hemodialysis or peritoneal dialysis.

PURPOSE: The impact of different dialysis modalities on oxidative stress and inflammation and the factors implicated in this interrelationship have not been adequately studied. This study was designed to comparatively evaluate the effect of hemodialysis (HD) and peritoneal dialysis (PD) on oxidative stress and inflammatory biomarkers and to search for associated factors. METHODS: We studied 20 HD, 11 PD patients and 11 healthy controls. Calculations were based on total antioxidant capacity (TAC) and superoxide dismutase (SOD), by spectrophotometry, as oxidative stress biomarkers; and high sensitivity CRP (hs-CRP), Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-alpha), by ELISA, as inflammation biomarkers. RESULTS: HD and PD patients showed significantly increased levels of TA C, SOD and hs-CRP compared to healthy controls. No significant difference was observed in TNF-alpha and IL-6. Compared to HD patients, PD patients showed TNF-alpha levels that were increased, although non-significantly, and significantly higher homocysteine (Hcy). No differences were observed for IL-6, hs-CRP, TA C and SOD. In HD patients, significant positive correlations were found between intact parathyroid hormone (iPTH) and TNF-alpha, and between uric acid (UA) and TAC. Beta2-microglobulin (Beta2M) was negatively correlated with TAC, total cholesterol (TC) positively with TNF-alpha and negatively with SOD, and triglycerides (TG) correlated positively with TNF-alpha. In PD patients, TG correlated positively with TNF-alpha, HDL-cholesterol negatively with TNF-alpha, LDL-cholesterol negatively with SOD, and Beta2M negatively with SOD. CONCLUSIONS: HD and PD patients show similar degrees of inflammation and oxidative stress activation. Factors such as UA, iPTH, Beta2M and lipid profile correlate to oxidative stress and inflammatory biomarkers in both HD and PD patients.

Inflammation and oxidative stress in patients on hemodiafiltration.

BACKGROUND: Chronic inflammation and oxidative stress are common features in hemodialysis patients. However, research results on the long-term influence of hemodiafiltration (HDF) on oxidative stress and inflammation are limited. METHODS: We studied changes of inflammatory and oxidative stress biomarkers in 9 stable patients on post-dilution HDF for 9 months. Total antioxidant capacity (TAC), reactive oxygen metabolites (d-ROMs) and superoxide dismutase (SOD) measured by spectrophotometry were used as oxidative stress biomarkers. High-sensitivity CRP (hs-CRP) and IL-6 measured by ELISA were used as inflammation biomarkers. RESULTS: d-ROMs showed significant reduction at 3 months (323.0 +/- 81.9 vs. 275.0 +/- 62.0 U, p < 0.008) and remained low (267.9 +/- 45.8 U) to the end of the study. At the end of the study there was a significant increase in TAC levels (1.3 +/- 0.1 vs. 1.4 +/- 0.1 mmol/l, p < 0.03), while SOD rise did not reach statistical significance (13.1 +/- 9.8 vs. 18.7 +/- 9.4 U/ml, p = 0.06). hs-CRP values at the end of the study decreased significantly (16.3 +/- 11.4 vs. 6.0 +/- 5.1 microg/ml, p < 0.02), while IL-6 levels showed a non-significant reduction (16.9 +/- 9.3 vs. 12.0 +/- 7.3 pg/ml, p = 0.2). CONCLUSION: Our results suggest that post-dilution HDF for 9 months suppresses oxidative stress by rapid lowering of d-ROMs and improves antioxidant capacity by increasing TAC, while it reduces inflammation by decreasing hs-CRP.