Американский журнал передовой доставки лекарств Открытый доступ

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

Flávio José Dutra de Moura* , David da Silva Nunes, Beatriz Guterres Rodrigues de Sousa, Jaqueline Santos Ribeiro, Jonas Gonzaga do Nascimento, Amanda Macedo, Eloah Soares Povill Souza, Marcus Henrique Oliveira, Fernando Fontes de Souza, Vanessa Simioni Faria, Shirley Claudino Pereira Couto, Tatiana Karla de Santos Borges, Joel Paulo Russomano Veiga, Selma Aparecida Souza Kuckelhaus

Background: Once a diagnosis of chronic kidney disease (CKD) stage 5 is confirmed, possible treatments include kidney replacement therapies, such as hemodialysis (HD) and hemodiafiltration (HDF). HD removes low-molecular-weight molecules, while HDF purges small and large molecules, favoring the reduction of oxidative stress. Objectives: This study evaluated the hematological, biochemical and immunological parameters of individuals with CKD treated with HD who later converted to HDF.

Methods: This is a descriptive, retrospective and comparative study carried out with 25 individuals whose HD treatment was later converted to HDF (convenience sample).

Results: Data were analyzed in blood samples (cells and serum). Patient`s etiologies were type II Diabetes Mellitus (DM) (48%) and Systemic Arterial Hypertension (SAH) (32%). 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. 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.

Conclusion: Our results indicate that HDF is efficient in treating patients with CKD by improving most of immunological markers and maintaining the treatment efficacy. Considering that HDF is rarely used in Brazil, this a study is suggested to promote greater visibility and acceptance of HDF among patients and the medical community, aiming at its future implementation in the public health system.