Kidney Week

Abstract: TH-PO359

Comparison of Removal Efficiency and Biocompatibility Between Pre- and Post-Dilution On-line Hemodiafiltration

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

• Sakurai, Kenji, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan

Kenji Sakurai,

• Saito, Takeshi, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan

Takeshi Saito,

• Hosoya, Hiromi, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan

Hiromi Hosoya,

• Kurihara, Yoshitaka, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan

Yoshitaka Kurihara,

• Ishii, Daisuke, Kitasato University Hospital, Sagamihara Kanagawa, Japan

Daisuke Ishii,

• Yoshida, Kazunari, Department of Urology Kitasato University School of Medicine, Sagamihara, Japan

Kazunari Yoshida,

• Kokubo, Kenichi, Kitasato University School of Allied Health Sciences, Sagamihara, kanagawa, Japan

Kenichi Kokubo,

• Hyodo, Toru, Eijin Clinic and Cambodian Association of Nephrology, Hiratsuka, KANAGAWA, Japan

Toru Hyodo,

Background

In Japan in late-2016, 329,609 patients received dialysis, 24.2% of whom received hemodiafiltration (HDF). In 79% of HDF, the on-line mode is used, which is mostly performed with the pre-dilution mode (pre-HDF). However, in Europe, all HDF sessions use the post-dilution mode (post-HDF). We previously assessed differences in biocompatibility between pre- and post-HDF based on inflammatory markers and lymphocyte stimulation tests, and reported that pre-HDF is less physically stressful. Here, we used a more biocompatible hemodiafilter to study whether biocompatibility would differ between pre- and post-HDF, and assessed the solute removal efficiency of both modes.

Methods

Eight stable dialysis patients were included in this study. HDF was performed with Fineflux 210S eco (asymmetric triacetate membrane, NIPRO) at a blood flow rate of 250 mL/min and a total dialysate flow rate of 500 mL/min for 4 h/session. The substitution fluid volumes were 60 and 12 L/session for pre- and post-HDF, respectively. To test removal efficiency, urea, creatinine, b₂-microglobulin (MG) (MW:11.8kDa) and a₁-MG (MW:33kDa) levels were measured to determine the reduction rates. Albumin (Alb) leakage was also measured. To test biocompatibility, hs CRP, interleukin (IL)-6, tumor necrosis factor (TNF)-a, pentraxin (PTX)-3, intercellular adhesion molecule (ICAM)-1, and cluster of differentiation 62 platelet (CD62P; a platelet cell surface marker) levels were measured.

Results

Post-HDF was more efficient at removing small-molecular-weight solutes than pre-HDF. The reduction rate of b₂-MG was 81.2±2.6% for both modes. The reduction rates of a₁-MG were 33.1±5.8% for pre-HDF and 37.4±3.9% for post-HDF, showing a significant difference (p<0.05). Alb leakages (g/session) were 2.8 for pre-HDF and 3.4 for post-HDF (p<0.05). No differences between the two modes were observed in the rates of changes in CRP, IL-6, TNF-a, ICAM-1, and PTX-3 levels. Increases in the expression rates of CD62P were 164.7±24.1% for pre-HDF and 210.7±44.2% for post-HDF (p<0.05).

Conclusion

The percent change in the CD62P expression rate was smaller for pre-HDF than for post-HDF; platelets may have been less activated during pre-HDF than during post-HDF under this study’s conditions. Post-HDF was more efficient at removing solutes.

Funding

• Private Foundation Support