Abstract: SA-PO685

Calcium (Ca) and Phosphate (P) Balance in Short Daily Hemodialysis (SDHD) with the NxStage System One Cycler (NSO): Comparison with Standard Bicarbonate Dialysis (BHD)

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Brunati, Chiara Carla Maria, ASST Niguarda, Milano, Italy
  • Corciulo, Roberto, Azienda Ospedaliera Policlinico Bari, Bari, Italy
  • Gervasi, Francesca, University of Milan Bicocca, Milan, Italy
  • Casati, Costanza, University of Milan Bicocca, Milan, Italy
  • Corciulo, Simone, University of Foggia, Foggia, Italy
  • Gesualdo, Loreto, University of Bari, Altamura, BARI, Italy
  • Colussi, Giacomo, ASST Niguarda, Milano, Italy
Background

SDHD with NSO has gained popularity as home HD prescription. Short HD sessions, as in use with NSO, might not allow adequate removal of P, which benefits from time to optimize removal.

Methods

We compared single run and weekly balances of P and Ca, and changes in plasma levels, in 25 pts treated with NSO in 2 centers with different prescription: 14 pts (Milan) were prescribed 6 runs/week (dialysate 22.7±3.8L/run, time 154±23min/run), 11 pts (Bari) 4 or 5 runs/week (mean 4,8+0,48, dialysate 24,1±3,5, time 194±24). Data were compared to those in 14 pts treated with BHD (3/week, 4 hours, dialysate 500ml/min).

Results

Are shown in table 1.

Conclusion

Despite lower P removal per run in NSO, weekly removal was equal (Bari) or higher (Milan) than in BHD. More frequent NSO runs (6) are more efficient than less frequent runs (4/5). Plasma P decrease was quantitatively similar in NSO and BHD, despite lower run duration. P removal was directly correlated with pre-HD plasma levels in both NSO and BHD. Plasma Ca level increased less in NSO than in BHD, yet PTH fell along the run; Ca balance was correlated to basal Ca levels and net UF; at observed UF, it was negative at plasma Ca>8.5mg/dL.
Our data show that SDHD with NSO, despite lower run time and dialysate volume, allows similar P removal as compared to BHD; plasma Ca changes and balance do not substantially differ in NSO and BHD.

Table 1. P and Ca
 NSO-MilanNSO-BariBHDp
Plasma P, start (mg/dl)5.1+1.45.2+0.94.5+2.8n.s.°
Plasma P, end (mg/dl)2.7+0.8*2.6+0.7*2.2+0.5**0.02°
Net decrease (mg/dl)2.4+1.02.5+0.62.6+3.0n.s.°
Net removal (mg/session)-581.4+196.8-581.1+160.1-878.1+292.60.0006°
Weekly removal (mg)-3488+1181-2690+726.8-2634+8780.0037$
Plasma Ca, start (mg/dl)8.7±0.78.9+0.39.0±0.5n.s.°
Plasma Ca, end (mg/dl)9.4±0.6*9.3+0.4**10.0±0.5*0.0002°
Net increase (mg/dl)0.7±0.30.5±0.11.0±0.60.05°
Net balance (mg/session)-43.8±106.1-17.7±258.6-110.3±233.3n.s.°
Weekly balance (mg)-262.8±236.7-78.6±643.7-331.0±589.1n.s.°

Vs start: *p<0.0001, **p<0.006; °: vs NSO-Milan and Bari; $:vs NSO-Milan