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Abstract: FR-PO454

Effectiveness of Implementation of Hemodiafiltration and Achieving Target Convective Volume: Results from HDFit Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Guedes, Murilo Henrique, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
  • Larkin, John W., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Santos, Ana Claudia, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
  • Barra, Ana Beatriz Lesqueves, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Poli de Figueiredo, Carlos Eduardo, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
  • Cuvello neto, Americo Lourenço, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
  • Canziani, Maria Eugenia F., Federal University of Sao Paulo, Sao Paulo, Brazil
  • Strogoff-de-Matos, Jorge P., Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
  • Yazawa, Sinaia Canhada, Fresenius Medical Care, Rio de Janeiro, Brazil
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Canaud, Bernard J., FMC Deutschland GmbH, Bad Homburg, Germany
  • Pecoits-Filho, Roberto, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
Background

Hemodiafiltration (HDF) is associated with better outcomes compared to hemodialysis (HD), provided adequate convective volumes (CV) are achieved. Implementation of protocols targeting optimal CV have not been well described.

Methods

HDFIT was a randomized controlled trial studying the impact of postdilution high-volume online HDF versus high-flux HD on measured physical activity (NCT02787161). HDFIT included stable patients (Kt/V ≥1.2, permanent access, vintage ≥3 to ≤24 months). Clinic staff were trained to use Fresenius 5008 CorDiax® HDF machines the day before/morning of randomization visit. HDF was performed in 6-month follow-up with a CV target of 22L/treatment. We assessed implementation of HDF with a median achieved CV >22L across treatments.

Results


HDFIT randomized 195 patients (HDF n=97, HD n=98) at 13 clinics with mean age 53±15.1 years and 11% used a permanent catheter. There was an 8% and 11% dropout rate in HDF and HD groups. HDF group had 95 patients with CV data recorded (median=70 treatments/patient). Median treatment time was 235 (IQR 232 to 240) and 235 (IQR 233 to 240) minutes for HD and HDF.Median CV >22L was achieved in 86% (82 of 95) of HDF patients during follow-up. Monthly mean CV ranged from 24L to 25L (Figure 1). At 3-months, distinctions were found in mean Kt/V (HDF=1.8±0.4, HD=1.6±0.4; p<0.001) and phosphate (PO4) (HDF=4.8±1.3, HD=5.2±1.4 mg/dL; p=0.022). Distinctions were maintained at 6-months in mean Kt/V (HDF=1.8±0.5, HD=1.7±0.4; p=0.028), yet not PO4.

Conclusion

HDF was successfully implemented in the HDFIT trial with 86% of patients achieving protocol CV target. Monthly mean CV was consistently >22L in follow-up. HDF provided higher Kt/V throughout follow up and more PO4 removal at 3 months. HDF appears to be an easily implementable technique with brief training required.

Funding

  • Private Foundation Support