RESEARCH ARTICLE
Online Haemodiafiltration Improves Inflammatory State in Dialysis Patients: A Longitudinal Study Ines Rama1, Ines Llaudo´1, Pere Fontova1, Gema Cerezo1, Carlos Soto2, Casimiro Javierre3, Miguel Hueso1, Nuria Montero1, Alberto Martı´nez-Castelao1, Juan Torras1, Josep M. Grinyo´1, Josep M. Cruzado1, Nuria Lloberas1*
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1 Nephrology Department, Bellvitge University Hospital, IDIBELL. Barcelona, Spain, 2 Consorci Sanitari del Garraf. Sant Antoni Abad Hospital, Vilanova i la Geltru´, Barcelona, Spain, 3 Department of Physiological Sciences II, School of Medicine, University of Barcelona, Barcelona, Spain *
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Abstract OPEN ACCESS Citation: Rama I, Llaudo´ I, Fontova P, Cerezo G, Soto C, Javierre C, et al. (2016) Online Haemodiafiltration Improves Inflammatory State in Dialysis Patients: A Longitudinal Study. PLoS ONE 11(10): e0164969. doi:10.1371/journal. pone.0164969 Editor: Subbarao Bondada, University of Kentucky, UNITED STATES Received: April 8, 2016
Background Patients undergoing conventional hemodialysis (C-HD) present a greater immuno-inflammatory state probably related to uremia, sympathetic nervous system (SNS) activation and /or membrane bioincompatibility, which could improve with a technique-switching to online hemodiafiltration (OL-HD). The antigen-independent pathway activation of this modified immunologic state turns dendritic cells (DC) into an accurate cell model to study these patients. The aim of this study is to further evaluate the immune-inflammatory state of patients in C-HD assessed by DC maturation.
Accepted: October 4, 2016 Published: October 26, 2016 Copyright: © 2016 Rama et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: This study was supported by grants from Instituto de Salud Carlos III and Ministerio de Sanidad y Consumo (PI12/01564, PI15/00871) and Fondo Europeo de Desarrollo Regional (FEDER); and Bellvitge Hospital (Ajut HUB 2015, 15PNJ026). This study was also supported by Astellas European Foundation Award (13th European Society of Transplantation). NL is a researcher from ISCIII Miguel Servet (CP06/ 00067) and REDinREN. The funders had no role in
Methods 31 patients were submitted to C-HD and after 4 months switched to the OL-HD technique. Monocytes-derived DCs from HD patients were cultured in the presence of IL-4/GM-CSF. DC-maturation was evaluated by assessing the maturation phenotype by flow cytometry (FACs). DCs-functional capacity to elicit T-cell alloresponse was studied by mixed leucocyte reaction. Cytokine release was assessed by FACs and SNS was evaluated measuring renalase levels by ELISA.
Results An up-regulation of maturation markers was observed in C-HD DCs which induced two fold more T cells proliferation than OL-HD DCs. Also, C-HD-mDCs presented with over-production of pro-inflammatory cytokines (IL-6, IL-1β, IL-8, IL-10 and TNF-α) compared with OLHD-mDC (P
