Background: The biocompatibility of dialysis membranes is a determining factor in avoiding chronic microinflammation in patients under haemodialysis. Lower biocompatibility has been related to increased inflammatory status, which is known to be associated with cardiovascular events. Classically, cellulose membranes have been considered bioincompatible. A new-generation of asymmetric cellulose triacetate (CTA) membranes allows the performance of high convective transport techniques, but there have been no studies of their biocompatibility. The aim of the present study was to analyze and compare the biocompatibility characteristics of 4 membranes, including CTA, in online hemodiafiltration (OL-HDF) patients. Methods: We included 15 patients in -OL-HDF. After a 2-week washout period with helixone membrane, each patient was treated with the 4 membranes (polyamide, polynephron, helixone and CTA) for 4 weeks in a randomized order. The other dialysis parameters were kept stable throughout the study. We studied changes in markers of the activation of the complement system, monocytes, platelets, and adhesion molecules with the 4 membranes, as well as inflammatory parameters. Results: Biocompatibility was similar among the membranes. There were no sustained differences in complement activation, measured by C3a and C5a levels, or in platelet activation, determined by levels of P-selectin and platelet-derived microparticles (CD41a+). No differences were observed in activated monocyte levels (CD14+/CD16+) or in plasma levels of interleukin (IL)-1, IL-6, IL-10 or high-sensitivity C-reactive protein, although tumour necrosis factor-α levels decreased when the patients were dialyzed with CTA. No significant differences were found in markers of endothelial damage, assessed by levels of plasminogen activator inhibitor-1 and adhesion molecules (intercellular adhesion molecule-1 and vascular cell adhesion molecule-1). Conclusion: The 4 membranes evaluated in this study in stable patients on OL-HDF, including the new-generation CTA, show similar biocompatibility with the methods applied.

Keywords:
Biocompatibility, C-reactive protein, Chronic inflammation, Hemodiafiltration, Membrane
1.
Cheung AK. Biocompatibility of hemodialysis membranes.
J Am Soc Nephrol
. 1990 Aug;1(2):150–61.
2.
Kokubo K, Kurihara Y, Kobayashi K, Tsukao H, Kobayashi H. Evaluation of the Biocompatibility of Dialysis Membranes.
Blood Purif
. 2015;40(4):293–7.
3.
Hoenich NA. Update on the Biocompatibility of Hemodialysis Membranes.
Hong Kong J Nephrol
. 2004;6(2):74–8.
4.
Takemoto Y, Naganuma T, Yoshimura R. Biocompatibility of the dialysis membrane.
Contrib Nephrol
. 2011;168:139–45.
5.
Hakim RM. Clinical implications of hemodialysis membrane biocompatibility.
Kidney Int
. 1993 Sep;44(3):484–94.
6.
Craddock PR, Fehr J, Dalmasso AP, Brighan KL, Jacob HS. Hemodialysis leukopenia. Pulmonary vascular leukostasis resulting from complement activation by dialyzer cellophane membranes.
J Clin Invest
. 1977 May;59(5):879–88.
7.
Daugirdas JT, Bernardo AA. Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia.
Kidney Int
. 2012 Jul;82(2):147–57.
8.
Nagata K, Tsuji T, Todoroki N, Katagiri Y, Tanoue K, Yamazaki H, et al. Activated platelets induce superoxide anion release by monocytes and neutrophils through P-selectin (CD62).
J Immunol
. 1993 Sep;151(6):3267–73.
9.
Ando M, Iwata A, Ozeki Y, Tsuchiya K, Akiba T, Nihei H. Circulating platelet-derived microparticles with procoagulant activity may be a potential cause of thrombosis in uremic patients.
Kidney Int
. 2002 Nov;62(5):1757–63.
10.
Daniel L, Fakhouri F, Joly D, Mouthon L, Nusbaum P, Grunfeld JP, et al. Increase of circulating neutrophil and platelet microparticles during acute vasculitis and hemodialysis.
Kidney Int
. 2006 Apr;69(8):1416–23.
11.
Pecoits-Filho R, Bárány P, Lindholm B, Heimbürger O, Stenvinkel P. Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment.
Nephrol Dial Transplant
. 2002 Sep;17(9):1684–8.
12.
Varela MP, Kimmel PL, Phillips TM, Mishkin GJ, Lew SQ, Bosch JP. Biocompatibility of hemodialysis membranes: interrelations between plasma complement and cytokine levels.
Blood Purif
. 2001;19(4):370–9.
13.
Sichart JM, Moeller S. Utilization of hemodiafiltration as treatment modality in renal replacement therapy for end-stage renal disease patients–a global perspective.
Contrib Nephrol
. 2011;175:163–9.
14.
Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, et al.; ESHOL Study Group. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.
J Am Soc Nephrol
. 2013 Feb;24(3):487–97.
15.
Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, et al.; Turkish Online Haemodiafiltration Study. Mortality and cardiovascular events in online-hemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF study.
Nephrol Dial Transplant
. 2013;28:192–202.
16.
Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, et al. Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD.
J Am Soc Nephrol
. 2010 Oct;21(10):1798–807.
17.
Maduell F, Navarro V, Hernández-Jaras J, Calvo C. Comparación de dializadores en hemodiafiltración en línea.
Nefrologia
. 2000 May-Jun;20(3):269–76.
18.
Maduell F, Ojeda R, Arias-Guillén M, Fontseré N, Vera M, Rodas L, et al. A new generation of cellulose triacetate suitable for online haemodiafiltration.
Nefrologia
. 2018 Mar - Apr;38(2):161–8.
19.
Sánchez-Villanueva RJ, González E, Quirce S, Díaz R, Álvarez L, Menéndez D, et al. Reacciones de hipersensibilidad a membranas sintéticas de hemodiálisis.
Nefrologia
. 2014;34:520–5.
20.
Alvarez-de Lara MA, Martín-Malo A. Hypersensitivity reactions to synthetic haemodialysis membranes — an emerging issue?
Nefrologia
. 2014 Nov;34(6):698–702.
21.
Esteras R, Martín-Navarro J, Ledesma G, Fernández-Prado R, Carreño G, Cintra M, et al. Incidence of Hypersensitivity Reactions During Hemodialysis.
Kidney Blood Press Res
. 2018;43:1472–8.
22.
Ekdahl KN, Soveri I, Hilborn J Fellström B, Nilsson B. Cardiovascular disease in hemodialysis: role of intravascular innate inmune system.
Nat Rev Nephrol
. 2017;13:285–96.
23.
Poppelaars F, Gaya da Costa M, Faria B, Berger SP, Assa S, Daha MR, et al. Intradialytic Complement Activation Precedes the Development of Cardiovascular Events in Hemodialysis Patients.
Front Immunol
. 2018 Sep;9:2070.
24.
Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients.
Am J Kidney Dis
. 2000 Mar;35(3):469–76.
25.
Carracedo J, Merino A, Nogueras S, Carretero D, Berdud I, Ramírez R, et al. On-line hemodiafiltration reduces the proinflammatory CD14+CD16+ monocyte-derived dendritic cells: A prospective, crossover study.
J Am Soc Nephrol
. 2006 Aug;17(8):2315–21.
26.
Peng Y, Liu H, Liu F, Ouyang L, Cheng M, Gao L, et al. Atherosclerosis is associated with plasminogen activator inhibitor type-1 in chronic haemodialysis patients.
Nephrology (Carlton)
. 2008 Oct;13(7):579–86.
27.
Rogacev KS, Seiler S, Zawada AM, Reichart B, Herath E, Roth D, et al. CD14++CD16+ monocytes and cardiovascular outcome in patients with chronic kidney disease.
Eur Heart J
. 2011 Jan;32(1):84–92.
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