Abstract: TH-PO340
Short Frequent Haemodialysis at Home and Loss of Residual Renal Function
Session Information
- Dialysis: Dialysate and Clearance
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Beckwith, Hannah K.S., Lister Hospital, Stevenage, United Kingdom
- Kaja kamal, Raja mohammed, Lister Hospital, Stevenage, United Kingdom
- Greenwood, Roger N., Lister Hospital, Stevenage, United Kingdom
- Farrington, Ken, Lister Hospital, Stevenage, United Kingdom
- Vilar, Enric, Lister Hospital, Stevenage, United Kingdom
Background
The importance of preserving residual renal function (RRF) in dialysis patients has long been recognised with benefits in survival, nutrition and biochemical parameters. Frequent nocturnal haemodialysis (FNH) may accelerate loss of RRF but effects of short frequent haemodialysis (SFHD) are less clear. We studied rate of loss of RRF in our cohort of home SFHD patients, comparing to matched thrice-weekly in-centre haemodialysis (ICHD) patients.
Methods
We identified 2 cohorts of patients at our centre both of whom had intermittent measures of residual renal urea clearance (KrU). The SFHD cohort comprised patients initiating SFHD at home between 2009-2017. A separate control historical cohort of ICHD patients was used of those commencing dialysis 1989-2009.
Vintage from time of HD initiation was calculated for the SFHD cohort. Each patient was matched against 3 patients in the ICHD control cohort for KrU (±0.5ml/min) at the equivalent vintage (±6 months). Only KrU data after SFHD initiation was used in the SFHD cohort, and from the equivalent vintage time in matched controls. We compared trajectories of KrU decline in both cohorts, correcting for potential confounding variables.
Results
1073 patients were in the control cohort and 84 patients in the SFHD cohort. 24 patients on SFHD had ≥2 KrU measures following initiation but only 22 patients could be matched with 66 control patients according to the above criteria. KrU at SFHD initiation was 2.3ml/min(IQR 1.3-5.4) in the SFHD group and 1.7(IQR 1.0-4.9) in the control group,p=0.25.
Patients in the SFHD group were younger than control patients at the equivalent vintage time (50±SD17 v 64±SD14 years,p<0.001). There was no significant difference in frequency of diabetes, cardiac disease, peripheral vascular disease or gender between SFHD and control ICHD patients.
Slope of decline in kidney function was -0.8ml/min/yr(IQR -1.8 to 0.1) in the SFHD group and -0.5(IQR -1.2 to -0.1) in the ICHD control group(p=0.60). Using multiple linear regression to determine predictors of slope of decline in KrU, neither group (SFHD or ICHD) nor age or gender were independent predictors of KrU slope.
Conclusion
We did not find evidence that SFHD at home was associated with an increased rate of decline in RRF. Patients with RRF on home HD might benefit from SFHD rather than FNH, but this needs further exploration.