Can dialysis modality influence quality of life in chronic hemodialysis patients? Low-flux hemodialysis versus high-flux hemodiafiltration: a cross-over study.

BACKGROUND: Hemodiafiltration with online preparation of the substitution [online high-flux hemodiafiltration (OHDF)] and hemodiafiltration with prepared bags of substitution (HDF) are important, recently widely used renal replacement therapies in patients with end-stage renal disease. However, there is little information on the comparative impacts of these modalities versus conventional low-flux hemodialysis (HD) on the quality of life (QoL) of HD patients. This study investigates the effect of dialysis modality on QoL in chronic HD patients. METHODS: In this prospective, randomized, cross-over, open label study, 24 patients were enrolled. Their age were 62 ± 13.34 years (mean ± SD), with the duration of dialysis of 31 ± 23.28 months (mean ± SD). Five of the patients were women. QoL was measured by the Short-Form Health Survey with 36 questions (SF-36) and subscale scores were calculated. Each patient received HD, OHDF, and HDF for 3 months, with the dialysis modality subsequently being altered. They completed the questionnaire of QoL at the end of each period. RESULTS: There were statistical significant differences in QoL for the total SF-36 [36.1 (26.7-45.7) and 40.7 (30.2-62.8)], for classic low-flux HD and high-flux hemodiafiltration, for bodily pain [45 (26.9-66.9) and 55 (35.6-87.5)], and for role limitations due to emotional functioning [0 (0-33.3) and 33.3 (0-100)], respectively. The scores did not differ significantly between the two types of hemodiafiltration. CONCLUSIONS: Our study indicates that QoL differs significantly among patients receiving low-flux HD and high-flux hemodiafiltration, on total SF-36, bodily pain, and role limitations due to emotional functioning. Convective modalities may offer better QoL than diffusive HD.

Evaluation of leptin, interleukin-1beta, tumor necrosis factor-alpha and vascular endothelial growth factor in serum and follicular fluids of women undergoing controlled ovarian hyperstimulation as prognostic markers of ICSI outcome.

BACKGROUND: Cytokines play an important but controversial role during ovarian folliculogenesis for the development of mature and fertilizable oocytes. In this study, leptin, interleukin-1beta (IL1beta), tumor necrosis factor-alpha (TNFalpha) and vascular endothelial growth factor (VEGF) in serum and follicular fluids (FF) of women undergoing ovarian hyperstimulation were evaluated as prognostic markers of the outcome of intracytoplasmic sperm injection (ICSI) cycles. MATERIALS AND METHODS: Ninety-five ICSI cycles were included in the study. The cytokines were measured in serum and FF samples with enzyme immunoassay methods. RESULTS: The cytokine concentrations in serum were not significantly correlated with the cytokine concentrations in FFs. Serum IL1beta was inversely-correlated with the number of retrieved oocytes. Serum TNFalpha was negatively-correlated with fertilization rate. In FFs, TNFalpha was positively-correlated with leptin. Leptin and VEGF in FFs were negatively-associated with pregnancy outcome. CONCLUSION: Leptin and VEGF concentrations in FFs may serve as prognostic markers of success after ovarian hyperstimulation and ICSI.