Kidney Week

Abstract: SA-OR072

Online Haemodiafiltration Improves Inflammatory State in Dialysis Patients: A Longitudinal Study

Session Information

• Improving Dialysis Delivery and Patient Outcomes
  October 27, 2018 | Location: 2, San Diego Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Bhalla, Anil, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Anil Bhalla, MD, FASN



Curriculum Vitae of Dr. A.K. Bhalla Qualifications : MBBS : GMC, Amritsar MD (Medicine) 1981 PGI, Chandigarh DM (Neph) - 1987 PGI, Chandigarh MNAMS (Neph) – National Board of Exam., New Delhi Present Position : Co-Chairman, Deptt. Of Nephrology, Sir Ganga Ram Hospital, New Delhi Director Dialysis Services, Sir Ganga Ram Hospital, New Delhi Member, Board of Management, Sir Ganga Ram Hospital, New Delhi OFFICE BEARER OF SOCIETIES - Past Treasurer of Indian Society of Nephrology - Past Vice President of Indian Society of Nephrology - President of Society of Renal Nutrition and Metabolism - Past Secretary of Delhi Nephrology Society - Past President of Delhi Nephrology Society - Past Secretary- Cum-Treasurer of Peritoneal dialysis Society of India (PDSI) - Executive member of Indian Society of Hemodialysis - Organizing Secretary of Two Annual Conference of PDSI ( 2001 and 2007) - Treasurer of Annual Conference of Indian Society of Nephrology in 2007 - Treasurer of Annual Conference of Indian Society of Hemodialysis – in New Delhi 2004 - Organizing Secretary of Annual Nephrology Update of Delhi Nephrology Society – twice MAIN AREAS OF INTEREST - Peritoneal Dialysis - Vascular access in H.D. - ABO incompatible kidney transplant PUBLICATIONS - Around 60 National/International publications AWARDS - Awarded PADMA SHRI by the President of India in 2010 - Awarded Fellowship of Indian Society of Nephrology in 2007 - Awarded Fellowship of American Society of Nephrology (FASN) in 2016 - Awarded Fellowship of Royal College of Physicians (Edin) in 2018.

• Dhanuka, Ganesh, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Ganesh Dhanuka,

• Gupta, Ashwani, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Ashwani Gupta,

• Shingada, Aakash, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Aakash Shingada,

• Gaur, Lovy, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Lovy Gaur,

• Gupta, Anurag, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Anurag Gupta,

• Bhargava, Vinant, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Vinant Bhargava,

• Joshi, Anant, Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Anant Joshi,

• Rana, Devinder S., Sir Ganga Ram Hospital , New Delhi, New Delhi, India

Devinder S. Rana,

Background

We conducted this study to evaluate and compare the effect of online haemodiafiltration(OL-HDF) and conventional haemodialysis(C-HD) on the level of inflammatory markers (hs-CRP,IL1 ,IL6 and TNF- α) in Chronic Kidney Disease V (D).

Methods

In this prospective observational study we measured levels of hs-CRP, IL-1, IL-6 and TNF-alpha at baseline, 3months and 6 months. 60 patients (5 excluded, underwent transplant) with CKD V on C-HD for minimum 3 months were included. Study population was divided in two groups; 27 patients were continued on C-HD; 28 patients shifted on OL-HDF. Follow-up period was 6 months after randomization.

Results

Mean age was 50.22yrs. Mean Kt/v and dry weight were similar in both groups at baseline. Kt/v (P=0.78) & dry weight (P=0.591) remained stable in both groups after 6 months. Mean hs-CRP levels were similar in both groups at baseline (2.66±1.86 mg/dl vs 2.60±1.96 mg/dl; p=0.916) and at 6 months, there was significant reduction of hsCRP in the HDF group by 33%(p-0.007). Mean IL-1 levels were similar at baseline in both groups (177.30±41.86pg/ml vs 166.57±30.29pg/ml; p=0.280) and at 6 months, IL- 1 levels in HDF group decreased significantly (p<0.001) by 13 %. Mean IL-6 levels were similar at baseline in both groups (14.18±9.46pg/ml vs 12.74±7.63pg/ml; p=0.536) and at 6 months IL-6 levels in HDF group decreased significantly (p=0.001) by 33%. Mean TNF-α levels were similar at baseline in both groups (15.47±7.60pg/ml vs 14.87±7.48pg/ml; p=0.771) and at 6 months, TNF-α levels in HDF group decreased significantly (p=0.017) by 22 %. Mean Haemoglobin was similar in both groups at baseline (8.90±1.50gm/dl vs 9.16±1.33 gm/dl; p=0.498). At 6 months, haemoglobin was stable in HD group(p=0.426), while in HDF group it increased significantly (p=0.001) to 10.05±1.53gm/dl. This was associated with a significant decrease on rhEPO requirement in HDF group by 14% (p – 0.043). Mean S. phosphorous was similar in both groups at baseline (6.12±1.72mg/dl vs 6.07±2.05mg/dl; p=0.923). At the end of 6 month reduction in phosphorous in HDF group was significantly higher (p<0.001).

Conclusion

This study showed that CKD related inflammation improved significantly with online-HDF, with significantly decreased level of hs-CRP : 33% , IL-1 : 13% , IL-6 : 33% , THF- α : 22% after 6 months.