Abstract: TH-PO352
Medium-Range Molecule Extraction and Intradialytic Hemodynamics: Comparison of Two Convective Dialysis Methods
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
- Cordeiro, Isis SF, University of São Paulo, São Paulo, São Paulo, Brazil
- Romagnoli, Marina, University of São Paulo, São Paulo, São Paulo, Brazil
- Adao, Rodrigo S., University of São Paulo, São Paulo, São Paulo, Brazil
- Dos santos, Telma, University of São Paulo, São Paulo, São Paulo, Brazil
- de Mendonça, Mariana H., University of São Paulo, São Paulo, São Paulo, Brazil
- Santos, Edilene M., University of São Paulo, São Paulo, São Paulo, Brazil
- Silva, Bruno C., University of São Paulo, São Paulo, São Paulo, Brazil
Background
Online hemodiafiltration (olHDF) improves intradialytic hemodynamic (IH) stability in comparison to hemodialysis (HD), possibly by lowering dialysate temperature (DT) and increasing medium-range molecule extraction. Using medium cut-off dialyzers in HD machines (HDx) might exert similar effects on IH.
Methods
Prospective trial, in which 8 patients switched from olHDF to HDx. DT was set to 36 °C. Pre-dialysis Beta2 microglobulin (β2M) was measured both in blood and spent dialysate. IH was assessed by Finometer™ during the first and the last 15 minutes of each dialysis session. High-flux Diacap™ dialyzers (BBraun) were used in olHDF, and Theranova 400™ (Gambro) in HDx.
Results
Total convection volume in olHDF was 20.3±1.1L. Post minus pre dialysis variation of systolic blood pressure (ΔSBP), diastolic blood pressure (ΔDBP), stroke volume (ΔSV), cardiac output (ΔCO) and peripheral arterial resistance (ΔPAR) were similar between olHDF and HDx. Positive ΔPAR, indicating increased post-dialysis vascular tonus, was observed both in olHDF and HDx (table), yet correlation between ΔPAR and β2M extraction was observed in HDx (r=0.785, p=0.021), but not in olHDF (r=-0.096, p=0.85).
Conclusion
At a same DT, olHDF and HDx led to similar IH stability. β2M extraction was associated with increased intradialytic PAR only in HDx.
Study data, according to dialysis modality
| olHDF | HDx | p | |
| Ultrafiltration (L) | 2.77 ± 0.9 | 2.90 ± 1.0 | ns |
| β2M (ug/ml) | 23.2 ± 6.9 | 27.8 ± 5.5 | ns |
| β2M extraction (mg) | 122.1 ± 43.8 | 196.4 ± 31.3 | 0.023 |
| Δsystolic blood pressure (mmHg) | 8.7 (-9.9; 18.4) | 3.1 (-9.4; 10.1) | ns |
| Δdiastolic blood pressure (mmHg) | 3.1 (-0.8; 11.7) | 4.3 (-3.3; 8.9) | ns |
| Δstroke volume (ml) | -18.7 (-56.1; -1) | -26.1(-43.7; -22) | ns |
| Δcardiac output (l/min) | -1.3 (-2.6; -0.5) | -1.4 (-2.2; -1.3) | ns |
| Δperipheral arterial resistance (dyn.s/cm5) | 436 ± 675 | 252 ± 211 | ns |
Correlation: β2M extraction vs ΔPAR