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Kidney Week

Abstract: FR-PO475

High-Volume Predilution Online Hemodiafiltration (HVPO-HDF) Is the Ideal Blood Purification Method from an Amino Acid Nutritional View

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kato, Motoko, Eijin Clinic, Hiratsuka, Kanagawa, Japan
  • Urabe, Shunichiro, Eijin Clinic, Hiratsuka, Kanagawa, Japan
  • Hyodo, Toru, Eijin Clinic and Cambodian Association of Nephrology, Hiratsuka, KANAGAWA, Japan
  • Kitamura, Makoto, Kurata Hospital, Hiratsuka, Kanagawa, Japan
  • Hida, Miho, Kurata Hospital, Hiratsuka, Kanagawa, Japan
  • Kurata, Yasuhisa, Kurata Hospital, Hiratsuka, Kanagawa, Japan
  • Sakashita, Keiichiro, Laboratory of Dialysis Medical Care and Technology, Nagoya-city, Aichi, Japan
  • Kokubo, Kenichi, Kitasato University School of Allied Health Sciences, Sagamihara, KANAGAWA, Japan
Background

Elderly ESRD patients with sarcopenia and frailty have been recently increased in Japan. It was reported the amino acid losses were up to 6 to 12 g per HD session (Kidney Int. 1994;46: 830-7). It seems to be important to restrain these amino acid losses during dialysis session from the point of nutritional view. We analyzed the amino acid losses that occur on performing high volume pre-dilution on-line HDF (HVPO-HDF) and HD.

Methods

We compared the amino acid and albumin amount into the total waste fluid, reduction rate of β2-microgloblin (β2-MG) and Kt/V (urea) in same 9 patients (7 males, 4 diabetics, mean age: 71.4±2.5 years) when they received HVPO-HDF and HD. The treatment time is 4 hours, respectively. The mean blood flow rate was 200 mL/min, respectively. The dialysate flow rate was 200 and 500 mL/min, respectively. The replacement fluid flow rate was 400 mL/min and total replacement fluid volume was 90 in HVPO-HDF. Hemodiafilter MFX-21Meco(Nipro, Ltd) was used for HVPO-HDF and Dialyzer FX-220(Fresenius Ltd) was for HD. These hemodiafilter and dialyzer were designed to suppress albumin leakage as possible as during dialysis session.

Results

In the O-HDF group, the total amino acid, total non-essential, essential, branched-chain amino acid losses (4511±797* mg, 2892±772* mg, 1619±286* mg, 739±167* mg, respectively) were significantly lower than in the HD group (6309±1072mg, 4008±772mg, 2301±414mg,1058±263mg, respectively) (* p < 0.01). The albumin losses of both methods were almost same and extremely low (HVPO-HDF: 0.15±0.0 g, HD: 0.12±0.0).
In the HVPO-HDF group, the β2-MG reduction rate (69.8±5.0** %) was higher than in the HD group (65.3±5.0%) (** p < 0.05). The Kt/V (urea) values in the former and latter were 1.33±0.17** and 1.45±0.23, respectively.
The HVPO-HDF can restrain the amino acid loss more effectively than HD. Both of hemodiafilter and dialyzer which were used in this study showed extremely low albumin leakage. In the HVPO-HDF group, the β2-MG reduction rate was higher than in the HD group. The Kt/V (urea) of HVPO-HDF was within favorable range (>1.2).

Conclusion

This method is most powerful method to restrain amino acid and albumin losses in order to keep nutritional condition to avoid sarcopenia and frailty in elderly ESRD patients.