#1573 Effects of haemodialysis coupled with hemadsorption on uremic toxins removal, oxidative stress and cellular death.

Abstract Background and Aims The retention of middle-molecules and Protein Bound Uraemic Toxins (PBUT) in dialysis patients are directly linked to specific clinical complications such as anaemia, inflammation and cardiovascular disease leading to increased mortality. These toxins, not adequately cleared by current dialysis techniques, could be removed by adsorption as demonstrated in numerous studies on dialysis patients. Furthermore, in dialysis patients there's an increased inflammation and oxidative stress only partially attenuated by biocompatibility of newly developed membraned. This pathologic inflammatory response lead to tissue damage and cellular death. A particular form of programmed cellular death involving red blood cells is called Eryptosis and is detectable as changes in the morphology and in the shape of human erythrocytes. The aim of this study was to assess the safety of dialysis coupled with hemadsorption (HA+HD) in terms of biocompatibility and efficacy in terms of removal of middle-molecules and PBUTs. Method This was a preliminary analysis of a multicentre observational study that evaluated 4 dialysis session focusing on 7 chronic dialysis patients of our dialysis centre. Patients were treated with HA+HD with HA130 cartridge (Jafron) only in the early-week dialysis session and then returned to their usual prescription. Blood samples were taken before and after dialysis session in order to measure Eryptosis as a marker of biocompatibility and few uremic toxins to assess the efficacy of the treatment by using Removal Ratio. Eryptototic RBCs were identified by FS (cell volume dimension) and FITCAnnexinV-binding (Beckman Coulter, Brea, CA, USA) using Navios Flow Cytometer (Beckman Coulter, Brea, CA, USA). A minimum 100. 000 events were collected on each sample. Statistical analysis was performed using the SPSS Software package. A p-value of 0. 05 was considered statistically significant. Results This study was carried out on 7 patients (4 women) with a mean age of 65. 7 ± 11. 5 years and a median dialysis vintage of 33 months (IQR 28-51). All patients had AVF with Qb of 330 ml/min. Dialysis length was 210 minutes. We didn't find any differences between Eryptosis values measured before and after dialysis (Table 1), and between different timepoints. We found significant reduction of PTH (pre: 391. 5 ng/L, IQR 206. 5-602. 8 vs post: 162. 0 ng/L, IQR 95. 0-363. 3; p=0. 005) and β2-microglobulin (pre: 23. 10 mg/L, IQR 22. 1-24. 1 vs post: 6. 72 mg/L, IQR 6. 2-8. 3; p0. 005) throughout the dialysis session coupled with hemadsorption (Fig. 1). Conclusion In this preliminary analysis, we found that the association of Dialysis with Hemadsorption allows a great removal of middle molecular-weight uremic toxins without compromise biocompatibility and thus represent a better treatment option in patients with high retention of these toxins.