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On-Line Hemodiafiltration Reduces the Proinflammatory CD14⁺CD16⁺ Monocyte-Derived Dendritic Cells: A Prospective, Crossover Study

Julia Carracedo^*, Ana Merino^*, Sonia Nogueras^*, Diana Carretero^*, Isabel Berdud^*, Rafael Ramírez^*, Ciro Tetta, Mariano Rodríguez^*, Alejandro Martín-Malo^* and Pedro Aljama^*

^* Unidad de Investigación, Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain; and Fresenius Medical Care, Research Extracorporeal Therapies, Bad Homburg, Germany

Address correspondence to: Dr. Rafael Ramírez, Unidad de Investigación, Hospital Universitario Reina Sofía, Avda Menendez Pidal S/N, Córdoba 14004, Spain. Phone: +34-957-010452; Fax: +34-957-010452; E-mail: manuelr.ramirez.sspa{at}juntadeandalucia.es

Received for publication February 1, 2006. Accepted for publication May 16, 2006.

It is not known whether high convective transport may have a role in modulating the chronic inflammation of hemodialysis (HD) patients. The aim of this study was to evaluate the effect of on-line hemodiafiltration (OL-HDF) on proinflammatory peripheral monocytes: Percentage of CD14⁺CD16⁺ cells and their telomere length and spontaneous or bacterial DNA-induced production of cytokines (TNF- and IL-6). In a prospective, crossover study, 31 patients who were on high-flux HD (HF-HD) were evaluated. Patients underwent the following sequence of treatments (4 mo each): HF-HD (basal), OL-HDF (period 1), HF-HD (period 2), OL-HDF (period 3), and HF-HD (period 4). The dialysis characteristics were similar in the two modalities; the only difference was a higher convective transport in the OL-HDF than in the HF-HD. All patients who were on OL-HDF periods showed a significantly lower number of CD14⁺CD16⁺ cells than on HF-HD (18.5 ± 2.3 basal versus 13.6 ± 2.9 period 1 and 13.9 ± 2.3 period 3; P = 0.001). By contrast, HF-HD restored the number of CD14⁺CD16⁺ cells to the basal values (19.2 ± 2.8 and 18.6 ± 1.4, periods 2 and 4, respectively; NS). During OL-HDF periods, the reduction of CD14⁺CD16⁺ was paralleled by a decreased number of short telomere cells. Spontaneous or bacterial DNA-induced production of cytokines (TNF- and IL-6) was increased in HF-HD as compared with OL-HDF. In conclusion, these results demonstrate that as compared with HF-HD, OL-HDF markedly reduces the number of proinflammatory CD14⁺CD16⁺ cells and the production of TNF- and IL-6. Future studies are needed to assess the possible therapeutic effect of convective transport on chronic inflammation that is associated with HD.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673