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Abstract: FR-PO497

A Randomised Study Investigating the Effect of Medium Cut-Off Haemodialysis on Markers of Vascular Health Compared with Online Haemodiafiltration (MoDal Study)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kharbanda, Kunaal, Manchester University Hospitals, Sale, United Kingdom
  • Wilkinson, Fiona L., Manchester Metropolitan University, Manchester, United Kingdom
  • Herring, Annie Elizabeth, Manchester Metropolitan University, Manchester, United Kingdom
  • Mitra, Sandip, Manchester University Hospitals, Sale, United Kingdom
Background

Medium Cut-Off (MCO) Haemodialysis (HDx) provides improved clearance of larger middle molecules (up to 45kda) compared with high-flux haemodialysis. Inflammation and cardiovascular (CV) disease, characterised by endothelial dysfunction (ED) are intimately linked in this patient group. Expanded solute removal, through HDx could be biologically significant in modifying endothelial function and CV risk. Endothelial microvesicles (EMV) are a marker of ED and each log increase correlates with a 20-fold increase in CV and all-cause mortality in HD patients. The primary aim of this study was to investigate the effects of HDx treatment on EMV compared with haemodiafiltration therapy(HDF).

Methods

A single-centre, pilot, open-label, randomised controlled study with 1:1 simple randomisation to 6 months MCO therapy or continue on existing HDF therapy(NCT03510520). Pre-dialysis EMV (CD144+) was measured at baseline (T0), 3 months (T12) and 6 months (T24). Secondary outcome measures included inflammatory cytokines, a panel of larger middle molecules, body composition monitoring and patient-reported outcome measures.

Results

63 participants were randomised to either MCO or HDF and 50 participants (25 each group) completed the full protocol. Mean age was 62.8±16 years, 70% male, 60% Caucasian, 34% diabetic, 68% AVF/G as AV access with no significant difference between groups in these domains. Mean substitution volume in the HDF group was 20.8L±2.84 per session. There was a rise in EMV in the HDF group (change in mean EMV 0.145 logCD144+ EMV/ml at T12 [p>0.05], 0.269 at T24 [p<0.05) and fall in EMV in the MCO group (-0.18 T12 [p<0.05], -0.145 T24 [p<0.05]). Mean albumin change in the MCO group was -1.8±2.93 g/l vs 0 ±1.89g/l in the HDF group (p<0.05).

Conclusion

Switching from HDF to HDx therapy is associated with a reduction in plasma EMV levels at 3 months with a sustained reduction at 6 months. This is in contrast with a rise in plasma EMV levels seen within the same time period in those remaining on HDF. A fall in serum albumin is seen with HDx treatment within the limits expected. Mechanisms behind the changes seen require further exploration. In an era where equipoise still exists between diffusive and convective treatment modalities, HDx could be an important future direction.

Funding

  • Commercial Support