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Abstract: FR-PO457

Hemodialysis (HD) Using Super High-Flux Dialyzer Provides Comparable Efficacy with High-Volume Post-Dilution Online Hemodiafiltration (ol-HDF): A Prospective Crossover Randomized Controlled Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Thammathiwat, Theerachai, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Chariyavilaskul, Pajaree, Chulalongkorn University, Bangkok, Thailand
  • Susantitaphong, Paweena, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Srisawat, Nattachai, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Tiranathanagul, Khajohn, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background

Although high volume post-dilution online hemodiafiltration (ol-HDF) that could remove large toxin such as beta-2 microglobulin (B2M, MW 11.8 kDa) as well as protein-bound toxins especially indoxyl sulfate (IS) and subsequently improve survival of HD patients is now accepted as the best modality for chronic HD patients, the procedure is sophisticated and expensive. The present study was conducted to compare the efficacy in term of large and protein-bound uremic toxin removals between HD using novel super high-flux (SHF) dialyzer which has large pore size close to albumin, PES 17D alpha (Nipro, Japan) and ol-HDF in a non-inferiority fashion.

Methods

A prospective cross-over randomized controlled trial included twelve prevalent HD patients who were randomly allocated into 2 sequences of treatment period of SHF-HD treatment and later ol-HDF period or vice versa. Each treatment period took 12 weeks and divided by wash out phase of 4 weeks of HD using regular high-flux (HF) dialyzer. The primary outcome was removal of B2M in term of reduction ratio (RR). Other small, protein-bound and large uremic toxin removals, albumin loss, and nutritional parameters were also compared.

Results

SHF-HD provided comparable B2M RR with ol-HDF (78.8±4.7 and 76.8±8.1 respectively, p=0.152). In addition, B2M clearance, alpha-1 microglobulin (A1MG, MW 33 kDa) RR, A1MG clearance, and IS RR were also comparable. The spKt/Vurea was not different. Although the albumin loss in dialysate was higher in SHF-HD than ol-HDF(4.2±2.8 and 0.6±0.8 g/session, respectively), the serum albumin levels at baseline and after 12 weeks of SHF-HD treatment were significantly improved from 3.71±0.38 to 3.88±0.22 g/L (p<0.001) while they did not change during ol-HDF period. In addition, normalized protein catabolic rate was significantly increased in SHF-HD compared to ol-HDF (p=0.012) with no significant changed of lean tissue index after 3-month period of the study.

Conclusion

SHF-HD that lower cost and accessibility was non-inferior efficacy to ol-HDF in term of large, protein-bound and small uremic toxin removals without adverse effect on serum albumin which potentially improve long-term survival.

Funding

  • Private Foundation Support