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Abstract: TH-PO349

Six Months Evaluation of the Expanded Hemodialysis (Hdx) on Removal Efficiency, Anemia, and Quality of Life

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Gernone, Giuseppe, ASL BA - "S. Maria degli Angeli" Hospital - Putignano (Bari) - Italy, Putignano, Italy
Background

The High-Flux (HF) dialysers in standard-hemodialysis (HD) allow the removal of a wider spectrum of uremic toxin. However the HD can remove mostly low molecular weight solutes while the HDF can remove solutes around 15kDa, so-called Middle Molecules (MM), improving morbidity and mortality by exchange volumes >15L per session. The new medium cut-off (MCO) filter Theranova® is designed to expand the removal of toxins up to 45kDa in HD compared to HF membranes (HemoDialysis eXpanded, HDx) even with conventional blood flows and without exchange fluid infusion. The aim of this study is to evaluate the performance of HDx and its impact on anemia and quality of life (QoL) in hemodialysis patients (pts).

Methods

13 stable HD pts were enrolled (M/F 10/3, age 70.8±9) with Qb ≤300 ml/min in a six months’ observational case-control study. Each patient was evaluated first with HF filter (T0) and then in HDx for six months. Pre-dialysis (T0-T6) were evaluated: urea, phosphate (P), beta2-microglobulin (B2m), myoglobin (Myo), free light-chains K and λ (FLC-K and FLC-λ), C-Reactive Protein (CRP), hemoglobin (Hb) and albumin. Furthermore Kt/V, dose of EPO, ERI and SF-36 questionnaire were evaluated at the beginning and end of observation. We treat hemodialysis pts according to the KDIGO Guideline for Anemia in CKD. The values have been reported as mean±SD.

Results

HDx (Qb= 275 ± 41 ml/min, TT 215 ± 21 m) shows a significant increase in KT/V (T0 1,31 ± 0,23; T6 1,55 ± 0,17; p= 0.001) with relevant RR of: Urea 69%; P 56%; B2m 63%; Myo 55%; FLC-k 61%; FLC-λ 59%. There is a significant reduction at 6 months for FLC-λ (Tab.1). HDx reduced ERI (T0 9.8 ± 10.5; T6 4.4 ± 5.5; p <0.05) and EPO dose (T0 7692 ± 8518; T6 3615 ± 4464, p <0.05), keeping the Hb unchanged. QoL is significantly improved (ISF: T0 27.3 ± 10.1; T6 40.2 ± 8.4 p= 0.0001) (ISM: T0 43.8 ± 14.2; T6 51.1 ± 9.8 p= 0.001).

Conclusion

HDx effectively removes uremic toxins up to 45kDa, even with Qb <300 ml/min, without reducing serum albumin and with promising results on inflammation. Reduction of ERI and improvement of QoL are encouraging and suggest the use of HDx even in pts who cannot benefit from convective techniques because of vascular access or intolerance to high volumes of exchange.