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Abstract: SA-PO411

Improved Serum Phosphorous and Small Molecule Removal With Expanded Hemodialysis and Hemodiafiltration vs. Conventional Hemodialysis: A Cross-Over Randomized Clinical Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Vega, Olynka, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Caballero-Islas, Adrián Esteban, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Del Toro-Cisneros, Noemi, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Arvizu Hernández, Mauricio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Martinez-Rueda, Armando Jezael, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Camacho, Diana, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Correa-Rotter, Ricardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
Background

Expanded hemodialysis (HDx) with medium cut-off dialyzers is expected to provide enhanced permeability to medium sized molecules, selective solute retention, and better internal retrofiltration. The objective of our study was to compare clearance of different size molecules in 3 modalities: conventional hemodialysis (cHD), hemodiafiltration (HDF), and HDx.

Methods

A single-center cross-over study was conducted in prevalent hemodialysis. Patients were randomized to determine the initial modality of treatment (Figure 1). Blood samples were taken on the first and last session in each modality and pre and post treatment. We performed ANOVA to compare groups.

Results

Twenty-seven stable patients were randomized, 5 were excluded (Figure 1). Twenty-two patients completed the study and were included in the analysis. The removal of small solutes (BUN) was similar in HDF and HDx and less effective in cHD (p=0.048). There was no difference in reduction ratios for medium-sized molecules (CRP, IL6, IL10, TNFα), or in protein-bound p-cresol. We observed a decrease in serum phosphorous (P) in the HDx and HDF periods, contrary to what happened with cHD: (HDx 4.78 vs 3.99, HDF 5.09 vs 4.07, and cHD 4.51 vs 4.62) (Figure 2).There was no decrease in serum albumin in any of the modalities.The most frequent adverse event was intradialytic hypotension, without differences between groups.

Conclusion

HDF and HDx were more effective to remove small molecules vs cHD. In addition serum P values were lower in the end of period determination with HDF and HDx, which reflect a better removal of total body P with these two modalities.

Funding

  • Commercial Support