Kidney Week

Abstract: PUB150

Removal of Middle Molecules with Hemodiafiltration plus Hemoadsorption in Patients with Kidney Failure

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Reis, Thiago A., Fenix Nephrology, São Paulo, SP, Brazil

Thiago A. Reis, MD

• Biluca, Bruno Piubelli, Fenix Nephrology, São Paulo, SP, Brazil

Bruno Piubelli Biluca, MBA

• Guimaraes, Maria Gabriela, Nephrology Department, Hospital Ana Nery, Salvador, Brazil

Maria Gabriela Guimaraes, MD

• Andrade, Jessica Liara Felicio de, Fenix Nephrology, São Paulo, Brazil

Jessica Liara Felicio de Andrade, MS, MSc

• Goes, Miguel Angelo, Discipline of Nephrology, Federal University of São Paulo, São Paulo, Brazil

Miguel Angelo Goes, MD, PhD, FASN

• Watanabe, Andreia, Department of Pediatrics, Pediatric Nephrology Unit, Instituto da Criança e do Adolescente, University of São Paulo School of Medicine, São Paulo, Brazil

Andreia Watanabe, MD, PhD

• Ramirez Guerrero, Gonzalo, International Renal Research Institute of Vicenza, Vicenza, Italy

Gonzalo Ramirez Guerrero, MEd

• Ronco, Claudio, International Renal Research Institute of Vicenza, Vicenza, Italy

Claudio Ronco, MD

• Neves, Francisco R., Laboratory of Molecular Pharmacology, University of Brasília, Brasília, DF, Brazil

Francisco R. Neves, MD, PhD

• Almeida, Antônio Luiz Junqueira de, Fenix Nephrology, São Paulo, SP, Brazil

Antônio Luiz Junqueira de Almeida, PhD

Background

Hemodiafiltration (HDF) promotes a higher clearance of middle molecules compared to hemodialysis for patients with kidney failure. Whether the association of HDF plus hemoadsorption (Fig. 1a) using cartridges with styrene-divinylbenzene resin further enhances the removal of middle molecules is yet to be defined. We prospectively analyzed the removal of middle molecules in four patients undergoing simultaneous hemoadsorption in series with HDF.

Methods

Patients underwent 3-hour sessions of online HDF with post-filter replacement plus hemoadsorption. We measured the pre- and post-session concentrations of five middle molecules and albumin.

Results

Four patients performed a total of 23 sessions. Dialysis characteristics are presented in Table 1. In the sum of the 23 session, blood flow was 400 mL/min (IQR 350-400 mL/min), convective post-filter flow was 115 mL/min (IQR 105-115 mL/min), and dialysate flow was 500 mL/min (IQR 500-800 mL/min). The reduction ratio [i.e.,1 - (pre-session/post-session)] of parathormone (9.4 kDa), ß2-microglobulin (12 kDa), myoglobin (17 kDa), Prolactin (25 kDa), and lipase (33 kDa) are depicted in (Fig. 1b). There was a statistically significant increase in albumin (66 kDa) concentration between pre- and post-session (38.3 vs 40.0 g/L, p = 0.002).

Conclusion

Compared to previous results in HDF trials, where patients carried out 4-hour HDF stand-alone sessions, 3-hour HDF plus hemoadsorption sessions provide an equivalent or superior reduction ratio of five middle molecules.

Hemodiafiltration prescription