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Abstract: PO0938

The Effect of Predilution Online Hemodiafiltration on Body Composition, Nutritional Status, and Mortality

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Mizuiri, Sonoo, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Nishizawa, Yoshiko, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Okubo, Aiko, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Doi, Toshiki, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Yamashita, Kazuomi, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Shigemoto, Kenichiro, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan
  • Usui, Koji, Ichiyokai Ichiyokai Clinic, Hiroshima, Japan
  • Arita, Michiko, Ichiyokai East Clinic, Hiroshima, Japan
  • Naito, Takayuki, Ichiyokai Yokogawa Clinic, Hiroshima, Japan, Japan
  • Doi, Shigehiro, Hiroshima Daigaku Byoin, Hiroshima, Japan
  • Masaki, Takao, Hiroshima Daigaku Byoin, Hiroshima, Japan
Background

We evaluated the effect of predilution online hemodiafiltration (HDF) on body composition, nutritional status and all-cause and cardiovascular (CV) mortality in maintenance dialysis patients.

Methods

All subjects (n=215) had blood flow rate of ≥200 mL/min and underwent HDF with a convective volume of 40 L/session or hemodialysis (HD), 4h/session, 3 times/week. Predialysis clinical data and same day postdialysis body composition parameters based on BCM (Fresenius) were obtained at baseline in 46 patients on HDF and 169 patients on HD, and followed over 5 years. Logistic regression analysis for HDF, Kaplan–Meier analysis and Cox hazard analysis were conducted.

Results

In all subjects, age and dialysis vintage were 72±12 years and 73±6 months, respectively. Body mass index [22.4 (20.6–27.0) vs. 19.8 (16.4–22.7) kg/m2], lean tissue index (LTI) [13.2 (10.8–15.7) vs. 11.0 (9.3–13.2) kg/m2], geriatric nutritional risk index [94 (88–97) vs. 88 (81–93)], serum albumin [3.6 (3.3–3.8) vs. 3.3 (2.9–3.5) g/dl], creatinine, phosphate and magnesium were higher, but LDL-cholesterol (LDL-C) was lower in patients on HDF than those on HD (P<0.05). There were no significant differences in fat tissue index (FTI) [8.0 (5.5–11.2) vs. 7.8 (5.7–10.6) kg/ m2], overhydration (OH) [0.8 (−0.5–2.2) vs. 0.9 (0.3–2.1) L], C-reactive protein (CRP), Kt/Vurea or β2-microglobulin (β2m) between the groups. HDF was significantly (P<0.05) associated with serum albumin [odds ratio (OR):2.99], LDL-C (OR:0.98) and LTI (OR:1.22), but not with FTI, OH, CRP, Kt/Vurea or β2m. Cumulative 5-year survival rate was significantly higher in patients on HDF than those on HD (67.9 vs. 43.7%, P<0.01). For 5-year all-cause mortality, HDF [hazard ratio (HR):0.31], age (HR:1.03), albumin (HR:0.48) and LTI (HR:0.91) were significant predictors (P<0.05), while FTI and OH were not. For 5-year CV mortality, HDF (HR:0.20), age (HR:1.05), diabetes (HR:2.61) and LTI (HR:0.80) [or either FTI (HR:1.08) or OH (HR:1.22)] were significant predictors, respectively (P<0.05).

Conclusion

Predilution online HDF with substitution volume 40 (20–40) L/session, 3 times/week is associated with better nutrition, increased muscle mass, and improved all-cause and CV mortality, but not with body fat and OH in dialysis patients.

Funding

  • Private Foundation Support