Abstract: FR-PO044
Impact of Intermittent Online Hemodiafiltration vs. High-Flux Hemodialysis on Markers of Inflammation and Fluid Status Assessed by Bioimpedance Analysis in Septic AKI Patients: A Randomized Trial
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Nayak, Saurabh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Gupta, Krishan Lal L., Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Ramachandran, Raja, Nehru Hospital, Chandigarh, India
- Yadav, Ashok Kumar, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Sahni, Nancy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Background
In sepsis, fluid assessment is a widely accepted challenge. Traditional approaches have limited utility. Bioimpedance (BI) has been used in CKD patients for dry weight assessment and studies have shown cardiovascular benefits when BI was utilised for fluid status assessement. We aimed at comparing impact of two modes of clearance i.e online HDF and high flux HD on fluid status and inflammation markers as assessed by BI analysis.
Methods
This pilot study was conducted in PGIMER, India between Sep 2017 to Sep 2018. Non critically ill septic AKI patients requiring dialysis were included. Patients in ICU and those requiring more than one ionotrope and/or mechanical ventilation were excluded. Alternate day RRT was provided till renal recovery using either HD or online HDF with target effluent rate of 25 ml/Kg/Hour. High flux polysulphone dialyzer was used in both the arms. BI was performed using single frequency bioimpedance analyser at prespecified intervals i.e before commencement of RRT, alternate day for 1st week, weekly till discharge and during 1st and 3rd monthly visits. All patients were followed for a period of 3 months from discharge. Plasma cytokine (IL6 a& TNF alpha) levels were assessed before and after one week of RRT initiation.
Results
80 patients were randomized in each RRT arm. Baseline characteristics and sepsis parameters (qSOFA) were similar. Phase angle(PA), body cell mass(BCM), fat free mass(FFM) and Total body water(TBW) at baseline were comparable. No significant improvement in BCM and PA were noted at 1st month however significant improvement seen at 3rd month. Mean PA at initiation of RRT and at 1 month after discharge was 6.05 and 10.5 respectively (P= 0.628). Likewise, no difference in plasma cytokine clearance was noted between the arms. At 3 months, change in PA within the arms was significant (p<0.005), with no difference across the arms. BCM and PA correlated with qSOFA score and plasma cytokine levels throughout. Mean eGFR at day 30 was 37.28 ml/min and 30 day mortality was 12.5%.
Conclusion
Phase angle and body cell mass correlated with other traditional markers of sepsis. There was no differential impact of convective and diffusive clearance on PA and BCM when applied intermittently.
Funding
- Government Support - Non-U.S.