Protein-Bound Uremic Retention Solutes in Long Nocturnal Hemodialysis
Although remarkable progress has been made, chronic kidney disease still poses a major burden on both individual patients, as well as on society as a whole. There is a strong inverse relationship between decreasing renal function, as estimated by glomerular filtration rate, and mortality rate, especially death due to cardiovascular disease. The exact cause(s) remain to be elucidated. Uremic toxins might play an important role.
In the course of decreasing renal function the concentration of numerous intracellular and extracellular compounds vary from the non-uremic state. But still increasing number of uremic retention solutes are being identified. Renal replacement strategies aim to remove potentially harmful substances from the body. Traditionally much attention has been paid to small water-soluble molecules such as urea nitrogen and creatinine. Based on the results of the recent HEMO and ADEMEX studies, increases of small water-soluble solute removal above the level reached with modern dialysis techniques - hemodialysis, peritoneal dialysis (HD, PD) - seem not to be advantageous with regard to patient outcome. These findings may point to the importance of other distinct groups of uremic retention solutes. In view of the data described above, protein-bound solutes might be good candidates.
Several advantages of long duration hemodialysis have been observed, including a better control of blood pressure by decreasing extracellular fluid volume, lowering peripheral vascular resistance and improving endothelium-dependent and -independent vasodilation. A normalization of heart rate variability and improvement of left-ventricular function was noted as well. Furthermore, anemia control has been shown to be easier and several nutritional parameters improved in patients treated with long duration HD. The therapy results in higher small water-soluble solute removal, phosphate removal and greater elimination of larger molecules (e.g. β2-microglobulin).
It seems an appealing question whether a better control of the serum levels of protein-bound solutes can be achieved by long duration (nocturnal) hemodialysis. This might be another advantage of this therapeutic modality, or may even in part explain the better outcome of patients treated this way.
The study compares intermittent hemodialysis with long nocturnal hemodialysis with respect to serum concentrations of several protein bound uremic toxins, as well as solute removal.
|Study Design:||Observational Model: Case-Only
Time Perspective: Prospective
|Official Title:||A Multicentric Observational Study on the Removal of Protein-Bound Uremic Retention Solutes in Nocturnal Hemodialysis: A Cross-Sectional Analysis|
- removal of protein-bound retention solutes [ Time Frame: 1 dialysis session ] [ Designated as safety issue: No ]
Biospecimen Retention: Samples Without DNA
serum, urine, dialysate
|Study Start Date:||December 2006|
|Study Completion Date:||December 2008|
|Primary Completion Date:||December 2008 (Final data collection date for primary outcome measure)|
hemodialysis twice weekly 4 hours
group 1: twice weekly, four hours
nocturnal dialysis twice weekly 8 hours
group 2: twice weekly, eight hours
nocturnal hemodialysis, 8 hours every other night
group 3: every other day, eight hours
nocturnal hemodialysis, 8 hours, six times per week
group 4: six days a week, eight hours
|Monash Medical Centre|
|Clayton, Victoria, Australia, 3168|
|Geelong, Victoria, Australia, 3220|
|Virga Jesse Ziekenhuis|
|Hasselt, Limburg, Belgium, 3500|
|Universitaire Ziekenhuizen Leuven|
|Leuven, Vlaams-Brabant, Belgium, 3000|
|Principal Investigator:||Björn KI Meijers, MD||Universitaire Ziekenhuizen Leuven|
|Study Director:||Pieter Evenepoel, MD, PhD||Universitaire Ziekenhuizen Leuven|
|Principal Investigator:||Tom Dejagere, MD||Virga Jesse Ziekenhuis|
|Principal Investigator:||Nigel Toussaint, MD||Geelong Hospital|