MP544ONLINE HEMODIAFILTRATION ELIMINATES S ADENOSYLHOMOCYSTEINE MORE EFFICIENTLY THAN STANDARD HEMODIALYSIS

Abstract

Introduction and Aims: S-Adenosylhomocysteine (SAH) has been identified as a novel non-traditional cardiovascular risk factor. Patients with chronic kidney disease have dramatically elevated Plasma SAH levels, as the kidneys are the major site of SAH disposal. Until now, no strategies have been characterized which may lower SAH Plasma levels. We hypothesized that SAH may be more efficiently removed by online-hemodiafiltration than by standard hemodialysis, which may contribute to the survival benefit of HDF treatment. Methods: We recruited 88 dialysis patients, of whom 42 patients were treated with HD and 46 with online-HDF. Plasma SAH was measured before and after the dialysis treatment by using a HPLC-MS/MS system (Waters 2795 alliance HAT and Quatro Micro API tandem mass spectrometer). Results: Mean plasma SAH levels within the total cohort were 411.0 ± 156.3 nM. Plasma SAH levels correlated negatively with age (r=-0.391; P<0.001) and positively with the dialysis vintage (r=0.229; p=0.033) as well as with the length of a single dialysis session (r=0.314; p=0.003). We found no significant differences in predialytic plasma SAH levels between patients treated with HD and patients treated with HDF (HD: 401.9 ± 152.5 nM; HDF: 419.4 ±160.9 nM; p=0.604). However, SAH elimination was significantly higher in patients treated with HDF than in patients treated with HD (HD: 76.8 ± 8.8%; HDF: 81.3 ± 8,2%; p=0,016). Conclusions: Online-HDF eliminates plasma SAH more efficiently than conventional HD treatment. Randomized controlled studies should assess the prognostic implications of these findings.