SP628BENEFITS OF VITAMIN E-COATED VERSUS CONVENTIONAL MEMBRANES IN CHRONICHAEMODIALYSIS PATIENTS: A SYSTEMATIC REVIEW & META-ANALYSIS

Abstract

Introduction and Aims: Accruing evidence suggests that Vitamin E-coated membranes (VEMs) can improve inflammation, oxidative stress and anemia control in chronic hemodialysis patients. We aimed at conducting a systematic review and meta-analysis to assess potential benefits of these membranes on several patient- and dialysis-related outcomes. Methods: Cochrane CENTRAL, Ovid-MEDLINE and PubMed databases were searched for English-language articles without time or follow-up restriction. We included any controlled (randomized and non-randomized) trial comparing VEMs versus conventional-membranes. Endpoints of interest were a series of biomarkers pertaining to anemia status, inflammation, oxidative stress and dialysis efficacy/status. Results: From a pool of 426 articles retrieved, we found 60 studies matching our search criteria. VEMs significantly improved Erythropoietin Resistance Index (SMD -0.37; 95% CI -0.70, -0.03) but reduced transferrin saturation (MD -3.59 %; 95% CI:-5.44, -1.73) and had no impact on other indexes on anemia control, such as hemoglobin and hematocrit level, red blood cells (RBC) count, dose of ESAs and other parameters of iron status. As for oxidative stress, VEMs produced a significant decrease in thiobarbituric acid reactive substances (SMD -1.18; 95% CI: -1.98, -0.38), plasma and RBC malonylaldehyde (SMD -0.86; 95% CI: -1.31, -0.41 and -2.16; 95% CI: -3.88, -0.44, respectively) and a significant increase in blood and RBC vitamin E (SMD 0.79; 95% CI: 0.50, 1.08 and 0.89; 95% CI: 0.28, 1.50 respectively). Of note, VEMs use was associated with a significant decrease in IL-6 levels as compared with standard membranes (MD -2.25 pg/mL; 95% CI: -3.21, -1.30). No differences with respect to control were noticed on other endpoints of interest, such as lipid profile, dialysis adequacy (Kt/V), blood pressure, albumin and uric acid. Conclusions: In chronic hemodialysis patients, VEMs treatment seems to improve oxidative stress and inflammation. Blood cell vitamin E and ERI are among the parameters that appear to improve, whereas no impact was found on other dialysis parameters. Benefits of these membranes on anemia control and harder clinical outcomes need to be confirmed in future, targeted trials.