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Abstract: PO1130

Online High-Volume Hemodiafiltration Reduces Pre-Dialysis Levels of Indoxyl Sulfate Compared with High-Flux Hemodialysis: Results from the HDFit Multicentric Randomized Controlled Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • de Lima, Jordana Dinorá, Universidade Federal do Parana, Curitiba, PR, Brazil
  • Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Rodrigues, Silvia Daniele, Universidade Federal do Parana, Curitiba, PR, Brazil
  • Almeida, Ana clara Simões flórido, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Barra, Ana Beatriz Lesqueves, Fresenius Medical Care, Rio de Janeiro, RJ, Brazil
  • Canziani, Maria Eugenia F., Universidade Federal de São Paulo, Universidade Federal de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Cuvello neto, Americo Lourenço, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
  • Poli de Figueiredo, Carlos Eduardo, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil
  • Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Nakao, Lia S., Universidade Federal do Parana, Curitiba, PR, Brazil
Background

Although HDF improves the clearance and pre-dialysis concentration of middle size molecules, little is known about its effect on concentration of protein-bound uremic toxins (PBUT) particularly in comparison to HD. Here, we investigated whether HDF impacts pre-dialysis plasma levels of the PBUTs indoxyl sulfate (IxS), p-cresyl sulfate (pCS) and indole 3-acetic acid (IAA) compared to HD.

Methods

This is post-hoc analysis of the multicentric randomized controlled trial studying the impact of HDF versus hf-HD on measured physical activity (HDFit - clinicalTrials.gov: NCT02787161), which included clinically stable HD patients with a vintage >3 to <24 months. Total plasma levels of IxS, pCS and IAA were determined by high performance liquid chromatography with fluorescence detection at baseline, 3 and 6 months. Mean difference in pre-dialysis PBUTs between HDF and hf-HD during the 6 months was estimated by linear mixed effect models.

Results

One hundred ninety-three patients (mean age 53 years old, 70% males and 60% white) were analyzed. There were no differences between HD and HDF groups regarding clinical and biochemical characteristics at the baseline. In the HDF group, 99% of patients achieved a convective volume higher than 22 L. The mean differences (95% CI) in concentrations over time for PBUTs among HDF and HD groups are shown in the Figure.

Conclusion

In this post-hoc analysis of the HDFit trial, high-volume HDF consistently reduced pre-dialysis concentration of IxS compared to hf-HD. These results demonstrate the sustained effect of mixed-diffuse convective methods in the removal of PBUTs compared to predominantly diffuse techniques.

Figure - Mean differences between groups in the change from baseline along with 95% confidence intervals (CI). Results shown IxS favored by HDF compared to HD.