Exploring the Impact of Expanded Hemodialysis with Super-High-Flux Dialyzer on Inflammation and Gene Expression: A Prospective Cohort Study in Prevalent Hemodialysis Patients.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2026-01-01 Epub Date: 2026-04-10 DOI:10.1159/000551822

Theerachai Thammathiwat, Tantip Arigul, Thidathip Wongsurawat, Piroon Jenjaroenpun, Prapat Suriyaphol, Watchara Pichitsiri, Supinda Sirilak, Noppakao Kongtal, Suri Tangchitthavorngul, Parttarawee Damee, Pajaree Chariyavilaskul, Jira Jongcharoenkamol, Anuchit Phanumartwiwath, Kullaya Takkavatakarn, Paweena Susantitaphong, Somchai Eiam-Ong, Sutatip Pongcharoen, Khajohn Tiranathanagul

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引用次数: 0

Abstract

Introduction: End-stage kidney disease (ESKD) features chronic inflammation and immune dysregulation. The effects of long-term expanded hemodialysis (HDx) using a super-high-flux (SHF) dialyzer on peripheral blood mononuclear cell (PBMC) transcriptomes and circulating inflammatory markers are unclear.

Methods: In a single-center pilot study, 10 prevalent hemodialysis patients were evaluated at baseline on standard high-flux hemodialysis and after 12 months on high-efficiency HDx delivered with an SHF dialyzer (ELISIO-17Hx; Nipro, Osaka, Japan). PBMC RNA sequencing was performed by Macrogen (Seoul, South Korea). Serum cytokines/chemokines were quantified by bead-based multiplex immunoassay on the Luminex xMAP platform (MILLIPLEX; Merck, Darmstadt, Germany). Differential expression controlled the false-discovery rate; paired tests compared biomarker levels.

Results: Out of 43 genes analyzed, 12 showed significant upregulation. TNF and CCL4 genes were notably altered after 12 months of HDx (adjusted p = 0.037 and p = 0.025). Serum levels of pro-inflammatory markers - TNF-α, CCL4, CCL2, and MMP-9 - significantly declined, while IL-10 increased (p < 0.001). Specific changes included TNF-α (31.5 [29.2-35.2] to 26.9 [23.7-30.9] pg/mL; p = 0.028), CCL4 (32.5 ± 14.1 to 22.7 ± 8.2 pg/mL; p = 0.015), CCL2 (489.6 ± 97.0 to 319.6 ± 103.5 pg/mL; p < 0.001), and MMP-9 (5,241.5 [4,432.3-19,709.3] to 555.6 [202.0-709.3] pg/mL; p = 0.005). IL-10 increased from 2.80 ± 1.86 to 5.15 ± 2.10 pg/mL (p = 0.001). TNF-β showed a nonsignificant change (mean difference -2.4; p = 0.101). Other markers remained unchanged.

Conclusion: ESKD shows PBMC upregulation of TNF and CCL4, whereas 12-month high-efficiency HDx lowers circulating TNF-α, CCL4, CCL2, and MMP-9. This transcriptome-serum discordance highlights immune dysregulation, while HDx appears to attenuate inflammation; the shift toward anti-inflammatory signals suggests potential clinical benefit.

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探索超高通量透析器扩大血液透析对炎症和基因表达的影响：一项流行血液透析患者的前瞻性队列研究。

终末期肾病（ESKD）以慢性炎症和免疫失调为特征。使用超高通量（SHF）透析器的长期扩展血液透析（HDx）对外周血单个核细胞（PBMC）转录组和循环炎症标志物的影响尚不清楚。方法：在一项单中心试点研究中，对10例常见的血液透析患者进行基线时的标准高通量血液透析（HF-HD）和12个月后的高效高通量血液透析（hhd）（ELISIO-17Hx; Nipro，大阪，日本）评估。PBMC RNA测序由Macrogen （Seoul, South Korea）进行。血清细胞因子/趋化因子在Luminex xMAP平台（MILLIPLEX; Merck, Darmstadt, Germany）上通过基于头部的多重免疫分析法进行定量。差异表达控制了错误发现率；配对测试比较了生物标志物水平。结果：在分析的43个基因中，有12个基因表达显著上调。肿瘤坏死因子（TNF）和CCL4基因在HDx治疗12个月后显著改变（调整p=0.037和p=0.025）。血清促炎标志物TNF-α、CCL4、CCL2和MMP-9水平显著下降，而IL-10水平升高(p结论：ESKD显示PBMC上调TNF和CCL4，而12个月高效HDx降低循环TNF-α、CCL4、CCL2和MMP-9。这种转录组-血清不一致突出了免疫失调，而HDx似乎减轻了炎症；向抗炎信号的转变表明了潜在的临床益处。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.