Abstract
Although the clearance of uremic toxins is comparable between expanded hemodialysis using a medium cut-off dialyzer (MCO+HDX) and online hemodiafiltration (OL-HDF), their effects on pro-inflammatory mediators have not been clarified. This study conducted a randomized cross-over study involving 12 thrice-weekly patients with hemodialysis who sequentially received MCO+HDX and OL-HDF with a washout period. Microparticles (MPs) and neutrophil activation were evaluated pre- and post-dialysis. OL-HDF showed elevated post-dialysis annexin V-positive MPs, predominantly from platelets and neutrophils. In vitro, post-dialysis MPs from both modalities aggravated human coronary artery endothelial cell (HCAEC) dysfunction. OL-HDF also enhanced post-dialysis neutrophil activation, as shown by elevated CD11b expression and plasma citrullinated histone H3 levels. These findings suggest that OL-HDF induces greater MP release and neutrophil activation than MCO+HDX, likely due to higher transmembrane pressures, which may contribute to endothelial damage and inflammation. The systemic impacts of HD modalities to induce both parameters might be clinically important.