Kidney Week

Abstract: SA-PO757

Impact of High Convective Volumes on Metabolic Profile and Body Composition of Diabetic Patients on Online Hemodiafiltration

Session Information

• Standard Hemodialysis for ESRD - I
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 601 Standard Hemodialysis for ESRD

Authors

• Macías, Nicolás, HGUGM, Madrid, Spain

Nicolás Macías,

• Linares, Tania, H.G.U. Gregorio Marañon, Madrid, Spain

Tania Linares,

• Vega, Almudena, Hospital Gregorio Marañón., Madrid, Spain

Almudena Vega,

• Torres aguilera, Esther, HGUGM, Madrid, Spain

Esther Torres aguilera,

• Santos, Alba, Gregorio Mara?on Hospital, Madrid, Spain

Alba Santos,

• Goicoechea, Marian, Hospital General Universitario Gregorio Marañon, Madrid, Spain

Marian Goicoechea,

• Verde, Eduardo, Hospital General Universitario Gregorio Marañon, Madrid, Spain

Eduardo Verde,

• Abad, Soraya, HOSPITAL GREGORIO MARAÑON, MADRID, Spain

Soraya Abad,

Background

OL-HDF with high convective volumes improves patient survival compared with high-flux hemodialysis. It has been proposed to limit the amount of convective transport in patients with diabetes mellitus, due to glucose load that is administered with replacement fluid. The aim of this study is to analyze the influence of substitution volume(SV) in the evolution of metabolic profile of diabetic patients incident on OL-HDF.

Methods

Prospective observational study in 29 diabetic patients incident on postdilution OL-HDF, three 4-hours sessions weekly. Baseline data included clinical, demographic, laboratory and body composition(BIS) parameters. Laboratory and SV were collected every four months, and in 23 patients another BIS was performed after a minimum follow-up of one year. Variations of glycosylated hemoglobin(HbA1c), triglycerides(TG), total cholesterol, LDL-c, HDL-c, albumin, prealbumin and C-reactive protein(CRP) were calculated at one-two-three years, and at the end of follow-up. Also quarterly and annual variations were calculated, as well as changes in body composition. Variations were collected to evaluate the influence of SV in these changes.

Results

Age at baseline was 69.7±13.6years, 62.1%male, with 48(35.5 – 76)months on dialysis, 72.3±13.9Kg weight, 27.1±5.4kg/m2 BMI, 1.78±0.16m² BSA. 81.5%received insulin, 7.4%antidiabetic drugs and 51.9%statins. Mean SV was 26.9±2.9L per session and follow-up(time on OL-HDF) was 40.4±26months.
We found significant correlation between SV and final changes in HDL-c(0.385,p0.039), prealbumin(0.404,p0.003) and CRP(-0.498,p0.007). Also convective dose adjusted with BSA was related with changes in HDL-c(0.393,p0.035) and inversely correlated with changes in TG(-0.423,p0.022) and CRP(-0.573,p0.007) since the second year of follow up. Quarterly comparisons(n 271) showed that quarterly SV correlated with variations in HbA1c(-0.146,p0.021). No correlation was observed between SV and changes in weight, body water, lean or fat tissue in the period between BIS measurements.

Conclusion

Higher convective dose is associated with a slight improvement in metabolic profile in diabetic patients in OL-HDF. There is not evidence to restrict the convective transport in diabetic patients due to the glucose content of the replacement fluid.