SP560COMPARISON OF THE HEMODYNAMIC TOLERANCE AND THE BIOLOGICAL PARAMETERS OF FOUR ACETATE-FREE DIALYSIS METHODS IN A GROUP OF THRICE WEEKLY HEMODIALYSIS PATIENTS

Abstract

Introduction and Aims: The presence of 3-8 mmol/l of acetate in hemodialysis solutions leads to a significant mass being infused in the patients on on-line HDF exposing them to its inflammatory, vasodilatatory and cardio-depressive effects. Citrate has been proposed as an optimal substitute for acetate The aim of the present trial was the comparison of the hemodynamic and biological parameters on a group of patients dialysed consecutivelly with 4 acetate-free hemodialysis techniques. Methods: In a prospective crossover study we measured the hemodynamic and biological effects of four acetate-free hemodialysis methods: the Acetate free Biofiltration with variable potassium (AFBK) and three methods with a citrate buffer, the conventional Hemodialysis (HD), on-line hemodiafiltration (HDF) and on-line Hemofiltration (HF). Fourteen chronic hemodialysis patients (9 males mean age 72.21 ± 11.21 years old) underwent 6 four-hour dialysis sessions for 2 weeks on each of the 4 studied techniques Results: The AFBK technique was associated with a minimal rate of intradialytic hypotensive episodes (1 in 84 sessions) compared to the other techniques (HD: 29/84, HDF 22/82 and HF: 14/78, p<0.001). The results for the systolic blood pressure (SAP) arre shown in Table 1. The same differences were found concerning the diastolic arterial pressure. On AFBK the net Ultrafiltration (UF) (p<0.001) and the UF as a percentage of the dry weight (p=0.005) were significantly higher. Regarding the biological parameters, after the first, second, third hour and at the end of the dialysis session there were significant differences between groups concerning the serum Sodium (Table 2) , Potassium, Calcium, Phosphate Urea, Creatinine and Magnesium concentrations. Concerning the hourly reduction of serum potassium and sodium concentration (Table 3) there was a significant difference between the four methods during the first hour of dialysis and no differences thereafter. There were significant differences between the methods concerning the efficacy of the dialysis KT/V (p<0.001) and the nPCR (p=0.015) with AFBK and HF presenting the lowest values A significant correlation between the prevalence of hypotensive episodes and the change of serum sodium (p<0.001) as well as potassium levels (p=0.002) during the first hour of dialysis was detected. There were no correlations between these parameters after the first dialysis hour. Conclusions: AFBK technique is associated with lesser hypotensive episodes and a better tolerance of the dialysis session. The rate of intradialytic modification for the serum electrolytes has been found to correlate with the dialytic hemodynamic tolerance. (Table Presented).