This is a randomized controlled crossover trial (58) in order to characterize PBL damage and death rate in hemodialysis patients treated with membranes with different permeability, including protein-leaking dialysers. The study will enroll fourty patients on regular 4-h three times per week hemodialysis (HD) of the dialysis unit of the "Fondazione IRCCS Policlinico San Matteo" (Pavia, Italy). Thirteen age and sex matched healthy individuals (Ctr) and ten CKD patients on peritoneal dialysis treatment (PD\*) will be included as healthy and CKD-matched controls, respectively. Comparison between HD and PD patients is aimed to assess the effect of biocompatibility and protein leakage during the treatments
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Hemodiafiltration with polymethyl methacrylate (PMMA)-based membrane
Hemodiafiltration without polymethyl methacrylate (PMMA)-based membrane
Fondazione IRCCS Policlinico San Matteo di Pavia
Pavia, Pavia, Italy
Comparison of the filters in term of the reduction of plasma HMWs and PBL death levels in a cross-over design
Time frame: up to 24 months
Identification of plasma proteins composition of the uremic retentates.
Time frame: day 0, day 90, day 180
Pharmacological manipulation of the cellular redox in THP-1 human leukocytes exposed to uremic retention solutes.
Thiol metabolomics and pharmacological manipulation of the cellular redox in THP-1 human leukocytes exposed to uremic retention solutes
Time frame: day 0, day 90, day 180
Proteomics studies of the role of GSTP hyperexpression in the modulation of Nrf2 expression and activity in uremic leukocytes.
Time frame: day 0, day 90, day 180
Study on transcription factors alternative to Nrf2
Study on transcription factors alternative to Nrf2 using human and murine Nrf2 inhibited monocyte lines
Time frame: day 0, day 90, day 180
Study of Nrf2/GSTP stress response pathway in the PBL and THP-1 human monocytes
Study of expression and activity of the Nrf2/GSTP stress response pathway in the PBL and THP-1 human monocytes exposed to isolated uremic retention solutes.
Time frame: day 0, day 90, day 180
Study of cell death in PBL freshly isolated from study groups
Study of cell death in PBL freshly isolated from study groups before and after treatment with autologous and heterologous whole plasma or isolated HMW fractions (studies of the IPR mechanism)
Time frame: day 0, day 90, day 180
Analysis of CD4+ cells from blood samples and assessment of inflammatory cytokines after LPS stimulation
Purification and culture of CD4+ cells from blood samples and assessment of inflammatory cytokines (IL-4, IL-10, IL-12 p70, IL-18, and IFNγ) after LPS stimulation
Time frame: day 0, day 90, day 180
Determination of lymphocyte subpopulations ex vivo
Time frame: day 0, day 90, day 180
Pathway analysis of the differentially expressed proteins of PBL and of principal component of complement system
Time frame: day 0, day 90, day 180
Analysis of HMWs characteristic oxidative PTMs in plasma and PBL lysate samples collected
Time frame: day 0, day 90, day 180
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