Abstract: SA-PO1078
Daily Home Hemodialysis (DHHD) in Large Patients: Observation and Data from the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) Cohort
Session Information
- Home Hemodialysis
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Hemodialysis
Author
- Fessi, Hafedh, Hopital Tenon, Paris, France
Introduction
Obesity is steadily increasing among HD patients (15–26% in W.Europe), responsible for high morbidity and mortality due to multiple metabolic abnormalities and cardiovascular risk factors: insulin resistance, infections, hypertension, sleep apnea… and for reduced mobility. Kt/V target is poorly evaluated as usual formulas overestimate V.
Case Description
: A male patient aged 34, 200kg weight, BMI 54.2kg/m2, presents CKD5 due to segmental and focal hyalinosis, is dialyzed incenter 3x5h=15h/week for 3 years, complains of severe fatigue and joint pain reducing his mobility, and of restless leg syndrome disrupting his sleep, stops working but agrees to train on SystemOne. Prescription is 6x150mn=15h/week, same duration as incenter. Dialysate and blood flow rates are 200 and 450ml/min. Restless leg syndrome disappeared and he complains less of fatigue at 4 weeks. Mobility improved and he returns to work after 2 months. Joint pain decreased at 6 months. Biological parameters improve as early as week 4: decrease in pre-dialysis urea 23 vs 38mmol/l and b2m 15.3 vs 21.4mg/l. Albuminemia increases from 35.9 to 45.6 g/l. Phosphoremia is stable, phosphorus chelators unchanged. Fistula used daily for 2 years (buttonhole) doesn’t present complication.
Discussion
The retrospective Cohort Study KIHDNEy involved 219 patients on DHHD in 5 European countries. 101 patients (46.8%) had a normal BMIn, avg 21.8kg/m2, 47 patients (21.8%) had a high BMIh, avg 36.3kg/m2 (30.1–53.7). 68.1% of BMIh patients were male, aged 51.7±11.4.
66.0% of BMIh dialyzed ≥6x/week, cumulative time was 16.6±3.1h/w vs 14.0±3.6 for BMIn. Ultrafiltration rate was low, 4.6±3.5 ml/kg/h vs. 7.4±5.0. Dialysate volume was greater: 38.3% used ≤25 L/session vs. 75.2%. Mean stdKt/V 2.5 at 6 and 12 months did not vary and was equivalent to BMIn, 2.6(p=0.91). Baseline phosphoremia did not change at 6 and 12 months (1.70, 1.73, 1.63mmol/l, p=0.44). PO4 chelators decreased by 17% (3.07, 2.92, 2.53 tablets, p=0.04). Antihypertensives decreased by 37% (1.44, 1.03, 0.91, p<0.01).
Conclusion: Evaluation of V with bioimpedance is recommended to customize prescription for obese and very large patients. Thus DHHD is adequate, with high clearance and low ultrafiltration. It improves clinical outcomes and quality of life, which are as good as normal size patients, and addresses the mobility challenge.