Abstract: FR-OR052

Preservation of Residual Renal Function in a European Cohort of Frequent Home Hemodialysis Patients

Session Information

  • Home Hemodialysis
    November 03, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 05:18 PM - 05:30 PM

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Nair, Sunita, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
  • Slon, Maria Fernanda, Complejo Hospitalario de Navarra, Pamplona, Spain

Group or Team Name

  • KIHDNEy Investigators
Background

Residual renal function (RRF) in dialysis patients promotes clearance of phosphate and middle molecules, permits more liberal fluid intake, and associates with improved survival. Intensive hemodialysis (HD) may accelerate loss of RRF, but whether all intensive HD schedules are similarly associated with deterioration of RRF is uncertain. We assessed the trajectory of 24-hour urine volume (UVol) in a European cohort of frequent home hemodialysis (HHD) patients.

Methods

We analyzed data from the KIHDNEy (Knowledge to Improve Home Hemodialysis Network in Europe) cohort, which comprises HHD patients at 9 centers in 5 Western European countries. All patients used the NxStage System One. Data about the HD prescription and 24-hour urine volume were collected at HHD initiation, 6 months, and 12 months. We retained patients with 24-hour UVol ≥500 mL at baseline and ≥4 sessions/week. We used generalized estimating equations to model changes in UVol between HHD initiation and 12 months.

Results

Baseline UVol was recorded in 98 (54%) of 182 patients, 44 (45%) of 98 had UVol ≥500 mL, and 43 (98%) of 44 dialyzed ≥4 sessions/week. Mean age was 51 years, 49% were female, median dialysis duration before HHD was 11.5 months, 9% had diabetes, and 19% had glomerulonephritis. Treatment frequencies were 5 and 6 sessions/week in 70% and 30% of patients, respectively, and mean treatment time was 12.2 hours/week. Mean UVol decreased (P = 0.001) from 1310 mL at baseline to 1080 mL at 6 months and 910 mL at 12 months. Cumulative incidence of anuria (UVol ≤50 mL) was 6% at 6 months and 18% at 12 months. Concurrently, mean ultrafiltration volume increased from 0.69 L at baseline to 0.85 L at 6 months and 0.96 L at 12 months. Antihypertensive medication use declined from 1.62 agents/day at baseline to 1.35 agents/day at 12 months. Concurrently, use of ACE inhibitors or ARBs declined from 28% to 16% of patients, while use of loop diuretics in non-anuric patients remained between 30% and 40%.

Conclusion

RRF decreased during 12 months of frequent HHD, with treatment time per week comparable to conventional HD. However, cumulative incidence of anuria was lower than with nocturnal HD in FHN (Daurgidas, Kidney Int, 2013), as well as lower than with peritoneal dialysis in NECOSAD (Michels, CJASN, 2011). Further research should assess whether specific approaches to intensive HD better preserve RRF.