Kidney Week

Abstract: TH-PO357

Removal of Large-Middle Molecules on Expanded Hemodialysis (HDx): A Multicentric Observational Study of 6 Months Follow-Up

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

• Cantaluppi, Vincenzo, University of Piemonte Orientale (UPO), Novara, Italy

Vincenzo Cantaluppi,

• Donati, Gabriele, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

Gabriele Donati,

• Lacquaniti, Antonio, Papardo Hospital, Messina, Italy

Antonio Lacquaniti,

• Cosa, Francesco, Ospedale Civile Di Legnano, Taranto, Italy

Francesco Cosa,

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

Giuseppe Gernone,

• Marengo, Marita, S.C. Nefrologia e Dialisi, ASLCN1, Savigliano, Italy

Marita Marengo,

• Teatini, Ugo, ASST Rhodense, Milano, Italy

Ugo Teatini,

Background

HemoDialysis expanded (HDx) may potentially represent an innovative way to remove uremic toxins of Large-Medium Molecular weight (LMMs, ≤45 Kda) thanks to the membrane medium cut-off (MCO, Theranova^®, Baxter). LMMs are involved in the pathogenic mechanisms of organ dysfunction associated with uremia including inflammation, malnutrition and atherosclerosis. The aim of this study was to evaluate the efficacy of LMMs removal in HDx during an observational multicentric study of 6 months follow-up.

Methods

41 HD stable patients (age 67,6±13,4) were dialyzed in HDx with Theranova^® 400 (1.7 m²). Each patient was evaluated at baseline with standard HD (T0), 3 months (T3) and 6 months (T6) after HDx. In the first session of the week (for each period), we evaluated the following pre-dialysis parameters: Urea, Creatinine (Creat), Phosphate (P), Beta2-microglobulin (B2m), Myoglobin (Myo), Free Light Chains (FLC-k, FLC-λ), Hemoglobin (Hb), Albumin and C Reactive Protein (CRP). Data are reported as mean ± standard deviation (SD).

Results

HDx therapy was well tolerated without evidence of major adverse side effects. The main results of the study are summarized in Figure 1. After 3 months of HDx (T3), we observed a significant decrease of pre-dialysis levels of urea (p=0,008), B2m (p=0,003), FLC-k (p=0,026), FLC-λ (p=0,001). No significant differences of the other uremic toxins between the periods (T3 vs. T6) were observed. Albumin levels remained stable during all the study period. A significant decrease of CRP was observed at T3 and T6, suggesting a positive effect of HDx on inflammatory parameters correlated with a worse outcome.

Conclusion

HDx therapy provided high removal of different LMMs, leading to a significant reduction of molecules involved in uremia-associated organ dysfunction in the first 3 months of treatment (T0-T3). Long-term studies with a larger sample size are needed to evaluate the clinical impact of HDx. However, our preliminary data suggest that HDx may improve LMMs removal and inflammatory parameters.

Figure 1: Pre-dialysis levels of different uremic toxins at study start (T0) and after 3 (T3) and 6 (T6) months of HDx.