Abstract: TH-PO344
Effect of Hemofiltration on Anemia, Adequacy, and Bone Mineral Disease in Hemodialysis Patients
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
- Abdelkhalek, Mostafa Abdelsalam, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Demerdash, Tarek M., DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Assem, Mohammed Mustafa, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Awais, Muhammad, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Shaheen, Mahmoud Maamoun, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Sabri, Ayman, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Salama, Hany AlAnany, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Jubran, Ibrahim Abduh, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Alobaili, Saad S., DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Al-Badr, Wisam H.A., DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Alsuwaida, Abdulkareem, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Kashgary, Abdullah, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
Background
Hemofiltration (HF) is not associated with lower mortality risk compared to standard hemodialysis (HD). However, there are many critical clinical outcomes in dialysis patients in addition to mortality; the impact of HF on these other outcomes is not clear.
Methods
This retrospective study included all patients referred to DaVita clinics in the Kingdom of Saudi Arabia. High-flux HD was the initial modality in all patients. Those who did not achieve adequacy targets or who had poorly controlled phosphorus were switched to post-dilution HF using 18-23L exchange per treatment. Patients dialyzing with a central venous catheter, patients who dialyzed less than 90 days at DaVita, and those with interrupted HF were excluded.
Results
Of the 1115 patients, 215 (19%) were on HF and 900 on high-flux HD; median follow-up was 6 months for all patients. The HF group showed a significant reduction in serum phosphate (p<0.001), a significant increase in serum calcium (p<0.012) and a significant improvement in Kt/V (p<0.0001). The HF group had significantly higher hemoglobin level than the HD group (p=0.024), with a significant reduction in weekly erythropoietin (ESA) dose after starting HF (p<0.001).
Conclusion
HF improved anemia, ESA dose, dialysis adequacy, and phosphate control in this retrospective analysis of a cohort selected for failure to meet Kt/V and phosphorus targets. Thus, HF can enable achievement of adequate dialysis care in some patients. Randomized-controlled clinical trials are necessary to confirm these findings.
Comparison of anemia, mineral bone disorder, and adequacy parameters before and after initiation of HF
| Parameters | Before HF | After HF | P-value |
| Serum phosphate, mg/dL, mean ± SD | 5.5 ± 1.58 | 5.15 ± 1.53 | <0.001 |
| Serum calcium, mg/dL, mean ± SD | 8.92 ± 0.82 | 9.1 ± 0.68 | 0.01 |
| Kt/V, mean ± SD | 1.53 ± 0.36 | 1.7 ± 0.43 | <0.001 |
| Hemoglobin, g/dL, mean ± SD | 11.15 ± 1.16 | 11.3 ± 1.08 | 0.3 |
| PTH, pg/ml, median (IQR) | 554 (556-85) | 537 (579-55) | 0.6 |
| ESA dose, IU/week, median | 10000 | 4000 | 0.001 |
Funding
- Commercial Support –