Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or Hemodiafiltration
Introduction: The low incidence of intradialytic hypotension (IDH) in high-volume (HV) hemodiafiltration (HDF) may help in maintaining gut perfusion during treatment. Preservation of gut endothelial integrity would limit or prevent bacterial translocation and subsequent systemic inflammation, which...
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Elsevier
2025-01-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924019557 |
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| author | Paul A. Rootjes Muriel P.C. Grooteman Andries E. Budding Hetty J. Bontkes Gertrude Wijngaarden Menso J. Nubé Camiel L.M. de Roij van Zuijdewijn |
| author_facet | Paul A. Rootjes Muriel P.C. Grooteman Andries E. Budding Hetty J. Bontkes Gertrude Wijngaarden Menso J. Nubé Camiel L.M. de Roij van Zuijdewijn |
| author_sort | Paul A. Rootjes |
| collection | DOAJ |
| description | Introduction: The low incidence of intradialytic hypotension (IDH) in high-volume (HV) hemodiafiltration (HDF) may help in maintaining gut perfusion during treatment. Preservation of gut endothelial integrity would limit or prevent bacterial translocation and subsequent systemic inflammation, which may contribute to the low mortality rate in HV-HDF. Methods: Forty patients were cross-over randomized to standard (hemodialysis [HD]) (S-HD), cool HD (C-HD), and HDF (low-volume [LV] and HV, convection volume (CV) of 15 L and ≥ 23 L per session, respectively), each for 2 weeks. Quantitative assessment of microbial DNA (mDNA) in blood was performed before and after dialysis by 16S to 23S interspace profiling after DNA isolation. The intradialytic acute phase response (APR) was evaluated by high-sensitivity C-reactive protein (hs-CRP), interleukin-6 receptor (IL-6R), soluble CD14 (sCD14), and vascular-cell-adhesion molecule-1 (VCAM-1). Differences between modalities were primary objectives. Results: mDNA was absent from all samples. IL-6R, sCD14, and VCAM-1 increased equally in all modalities (median increase: 12.5%, 14.0%, 14.8%, respectively; P < 0.05). hs-CRP increased only in C-HD and HV-HDF (median increase: 12.6%, P < 0.05). After correction for hemoconcentration, most APR markers decreased (median: sCD14, −11.3% and VCAM-1, −14.4% in all modalities; IL-6R, −13.4% in C-HD, LV-HDF, and HV-HDF; P < 0.05). hs-CRP only decreased in C-HD (−13.5%, P = 0.004). Conclusion: From this study, we conclude as follows: (i) circulating mDNA could not be demonstrated; (ii) in the crude analysis, a similar APR was noted in all modalities, individual markers remained stable or declined after correction for hemoconcentration; and (iii) because neither bacterial translocation nor an APR was observed in either modality, it is highly unlikely that the superior survival of HV-HDF is explained by a superior preservation of gut integrity. |
| format | Article |
| id | doaj-art-c69d255ab0da4306a87d7941e0745914 |
| institution | OA Journals |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Kidney International Reports |
| spelling | doaj-art-c69d255ab0da4306a87d7941e07459142025-08-20T02:05:52ZengElsevierKidney International Reports2468-02492025-01-0110110911910.1016/j.ekir.2024.09.025Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or HemodiafiltrationPaul A. Rootjes0Muriel P.C. Grooteman1Andries E. Budding2Hetty J. Bontkes3Gertrude Wijngaarden4Menso J. Nubé5Camiel L.M. de Roij van Zuijdewijn6Amsterdam UMC, location AMC, Nephrology, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences (ACS), Diabetes and Metabolism, Amsterdam, the Netherlands; Department of Internal Medicine, Gelre Hospitals, location Apeldoorn, Apeldoorn, the NetherlandsAmsterdam UMC, location AMC, Nephrology, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences (ACS), Diabetes and Metabolism, Amsterdam, the NetherlandsInBiome, Amsterdam, the NetherlandsDepartment of Clinical Chemistry, Medical Immunology Laboratory and Amsterdam Infection and Immunity, Amsterdam UMC, Amsterdam, the NetherlandsAmsterdam UMC, location AMC, Nephrology, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences (ACS), Diabetes and Metabolism, Amsterdam, the NetherlandsAmsterdam UMC, location AMC, Nephrology, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences (ACS), Diabetes and Metabolism, Amsterdam, the NetherlandsAmsterdam UMC, location AMC, Nephrology, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences (ACS), Diabetes and Metabolism, Amsterdam, the Netherlands; Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands; Correspondence: Camiel L. M. de Roij van Zuijdewijn, Amsterdam UMC, location AMC, Nephrology Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.Introduction: The low incidence of intradialytic hypotension (IDH) in high-volume (HV) hemodiafiltration (HDF) may help in maintaining gut perfusion during treatment. Preservation of gut endothelial integrity would limit or prevent bacterial translocation and subsequent systemic inflammation, which may contribute to the low mortality rate in HV-HDF. Methods: Forty patients were cross-over randomized to standard (hemodialysis [HD]) (S-HD), cool HD (C-HD), and HDF (low-volume [LV] and HV, convection volume (CV) of 15 L and ≥ 23 L per session, respectively), each for 2 weeks. Quantitative assessment of microbial DNA (mDNA) in blood was performed before and after dialysis by 16S to 23S interspace profiling after DNA isolation. The intradialytic acute phase response (APR) was evaluated by high-sensitivity C-reactive protein (hs-CRP), interleukin-6 receptor (IL-6R), soluble CD14 (sCD14), and vascular-cell-adhesion molecule-1 (VCAM-1). Differences between modalities were primary objectives. Results: mDNA was absent from all samples. IL-6R, sCD14, and VCAM-1 increased equally in all modalities (median increase: 12.5%, 14.0%, 14.8%, respectively; P < 0.05). hs-CRP increased only in C-HD and HV-HDF (median increase: 12.6%, P < 0.05). After correction for hemoconcentration, most APR markers decreased (median: sCD14, −11.3% and VCAM-1, −14.4% in all modalities; IL-6R, −13.4% in C-HD, LV-HDF, and HV-HDF; P < 0.05). hs-CRP only decreased in C-HD (−13.5%, P = 0.004). Conclusion: From this study, we conclude as follows: (i) circulating mDNA could not be demonstrated; (ii) in the crude analysis, a similar APR was noted in all modalities, individual markers remained stable or declined after correction for hemoconcentration; and (iii) because neither bacterial translocation nor an APR was observed in either modality, it is highly unlikely that the superior survival of HV-HDF is explained by a superior preservation of gut integrity.http://www.sciencedirect.com/science/article/pii/S2468024924019557hemodiafiltrationhemodialysisbacterial DNAintestinal translocationacute phase response (APR)randomized cross-over trial |
| spellingShingle | Paul A. Rootjes Muriel P.C. Grooteman Andries E. Budding Hetty J. Bontkes Gertrude Wijngaarden Menso J. Nubé Camiel L.M. de Roij van Zuijdewijn Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or Hemodiafiltration Kidney International Reports hemodiafiltration hemodialysis bacterial DNA intestinal translocation acute phase response (APR) randomized cross-over trial |
| title | Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or Hemodiafiltration |
| title_full | Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or Hemodiafiltration |
| title_fullStr | Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or Hemodiafiltration |
| title_full_unstemmed | Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or Hemodiafiltration |
| title_short | Randomized Trial Demonstrating No Translocation of Intact Intestinal Bacteria During Hemodialysis or Hemodiafiltration |
| title_sort | randomized trial demonstrating no translocation of intact intestinal bacteria during hemodialysis or hemodiafiltration |
| topic | hemodiafiltration hemodialysis bacterial DNA intestinal translocation acute phase response (APR) randomized cross-over trial |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924019557 |
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