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LONG-TERM SUPER HIGH-FLUX HEMODIALYSIS (OR EXPANDED HEMODIALYSIS;HDx) DOES NOT ALTER NUTRITION STATUS WITH THE SIGNIFICANTLY REDUCED MIDDLE-MOLECULE AND PROTEIN-BOUND UREMIC TOXINS IN HEMODIALYSIS PATIENTS
Kidney International Reports ; 8(3 Supplement):S329, 2023.
Artículo en Inglés | EMBASE | ID: covidwho-2283888
ABSTRACT

Introduction:

Super high-flux hemodialysis (SHF-HD) provides comparable effectiveness in terms of middle-molecule and protein-bound uremic toxin removal to online hemodiafiltration in prevalent end-stage kidney disease (ESKD). However, dialysate albumin loss is raised awareness of the long-term using SHF-HD. The study aims to monitor the long-term use of SHF-HD in nutritional status change and the sustained effect of uremic toxin removal. Method(s) The present study was prospectively conducted on the 15 prevalent ESKD patients from a run-in period of standard high-flux hemodialysis (HF-HD) with ELISIO-H21 dialyzer for 4 weeks to thereafter 15 months follow-up with SHF-HD. The patients provided high-efficiency (high blood flow and dialysate flow rate) SHF-HD using PES17D alpha dialyzers for the first three months. After the amendment protocol, SHF-HD was run with the same type of dialyzer;ELISIO-17Hx (Nipro Corporation, Osaka, Japan) due to the COVID-19 pandemic. Nutritional parameters, BCM;body composition monitor (FMC, Bad Homburg, Germany), and uremic toxins were measured at baseline and every three months during SHF-HD. Result(s) Fourteen of 15 patients could complete the study. One patient was early terminated due to undergoing kidney transplantation. After 15 months of SHF-HD treatment compared to HF-HD at baseline, there was not a statistically significant change in clinical and laboratory parameters on nutritional status. The mean serum albumin levels were 4.09 (1.36) versus 4.01 (0.3) g/dL, respectively (p=0.52), and the mean difference (SE) of normalized protein catabolic rate (nPCR) was -0.04 (0.08), 95% confidence interval [CI] -0.19, 0.11. On the other hand, lean tissue mass (LTM) was significantly decreased, and fat mass was significantly increased (mean difference (SE) of -3.66 (1.07) gram, 95% CI -5.76, -1.55, and 1.79 (0.80), 95% CI 0.21, 3.36). SHF-HD sustainably and significantly removed medium to large middle-molecule uremic toxins including pre-dialysis beta-2 microglobulin, kappa-free light chain, and lambda-free light chain. In addition, protein-bound uremic toxin;indoxyl sulfate was significantly reduced during long-term follow-up using SHF-HD. SHF-HD with PES17D alpha dialyzer resulted in more dialysate albumin leaks than a newer type of SHF-HD with ELISIO-Hx17. Conclusion(s) Long-term use of SHF-HD in ESKD patients was associated with nutritional safety and effectiveness in middle-molecule and protein-bound uremic toxin removal. Although serum albumin and BMI were not changed. LTM was significantly reduced with lower levels of nPCR than in other studies but trended to increase over time. The LTM absolute levels are not below the 10 percentiles of the healthy reference range. Increasing protein intake to reach the current recommendation and physical activity was advised with long-term use of SHF-HD to avoid further reduce LTM. [Formula presented] [Formula presented] [Formula presented] No conflict of interestCopyright © 2023
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Texto completo: Disponible Colección: Bases de datos de organismos internacionales Base de datos: EMBASE Idioma: Inglés Revista: Kidney International Reports Año: 2023 Tipo del documento: Artículo

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Texto completo: Disponible Colección: Bases de datos de organismos internacionales Base de datos: EMBASE Idioma: Inglés Revista: Kidney International Reports Año: 2023 Tipo del documento: Artículo