Abstract: PUB092
Hemodiafiltration (HDF) and Convective Volume (CV) Greater than 23 Liters per Session Without Patient Selection
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Attaf, David, Fresenius Medical Care France SAS, Paris, Île-de-France, France
- Mansour, Janette Kakomkate, Centre Hospitalier de Soissons, Soissons, OISE, France
Group or Team Name
- Hospital Soissons Dialysis Team.
Background
HDF ↓ mortality for CV > 23 L/session. The CV varies (clinical practices, patients). CONVINCE study shows it's possible to reach CV > 23 L with a protocol. Selection of patients without morbidity is still a debate. We assess CV achievement in unselected population.
Methods
Prospective monocentric study evaluating rate of patients with CV > 23 L/session with a CV protocol. Inclusion of all patients without selection. Follow-up with a protocol optimizing time, filtration fraction, blood flow Qb. Two phases study (fig.1) : CV optimization [Month1] then maintenance phase [Month 1-6]. At Month6 proportion of patients with CV = 23 L is assessed.
Results
67 pts included (47 HDF/20 HD) for HDF with CV optimizatjon (fig.1). Age 68 y, Male 57%, T2D 58%, UO < 300 ml/d 69%, CVC 27%. CV ↑ (+ 2L) at M1 with maintenance over time (fig2). During the study Qb ↑ from 283 (Mo) to 338 ml/mn (M6) (p < 0.01) ; Mbranes > 2m2 ↑ from 36 to 68% (p < 0.03) ; Kt/V ↑ from 1.2 (Mo) to 1.6 (M6) (p < 0.01). Positive correlation of Qb with fistula needle Φ (p < 0.01) ; of CV with time (p < 0.001) and Qb (p < 0.001).
Conclusion
CV ↑ from M0 to M6 (fig.2) as in D Zuijdewijn1 study. Nurse training allows to maintain CV over time and ↑ KtV. We face nurses resistance to ↑ Qb and needle diameter and patient resistance to ↑ time session (educational need). CV optimization protocol is feasible in daily practice (training need). Patient Related Outcomes Measure need to be assessed.(1)CKJ. 2017; 10.6: 804-812