FP721HEMODIAFILTRATION DECREASES MORTALITY IN PROTEIN ENERGY WASTING : PRELIMINARY RESULTS OF NUTRIPEPA STUDY

Abstract

INTRODUCTION: The role of large middle uremic toxins (LMUT) in the high mortality of protein energy wasting (PEW) is suspected. Hemodialysis (HD) or convective techniques with protein‐leaking dialysis membrane (pldm), adsorptive (ads) or not (non ads) could improve the clearance of LMUT but albumin loss is considered as potentially harmful. NUTRIPEPA is a multicentric randomized study comparing one year mortality of patients with PEW treated either with HDF or HD using a non ads mb versus an ads mb. METHODS: 67 patients with severe PEW having given their agreement to be enrolled were followed during 12 months : sex ratio : 0,48; mean : age : 74,3 (±12,7) y; BMI : 25,7 (±5,3) kg/m2; dry weight : 69,8 (±20,6) kg. PEW was defined as albumin<35 g/l (mean of 3 dosages) and prognostic inflammatory and nutritional index (PINI) >1. Treatment consists in 3∗4 hours HD session or in 3 HDF sessions with more than 20 liters reinjection/session. 26 patients were treated using HDF (HDF gr): 13 with non ads (HDF non ads gr) ; 13 with ads (HDF ads gr) (FDXGWPEPA membrane, Nikkiso Japan) and 41 with HD (HD gr) : 20 with non ads (HD non ads gr); 21 with ads (HD ads gr). Oral nutritional supplementation was systematic, eventually completed by intradialytic parenteral nutrition. Dry weight, BMI, albumin, CRP, orosomucoïde, prealbumin, PINI, nPCR and KT/V were evaluated each month. RESULTS: Percentage of death assessed by intention to treat was statistically decreased in the HDF gr compared to HD gr (p=0.015). The best one year survival (92%) was obtained in HDF ads gr. No significant variation of albumin concentration was observed in HDF group, whatever the type of membrane. CONCLUSIONS: Our preliminary results outline the interest of treating PEW with HDF without deletere effect on albumin concentration. The trend in benefit of HDF with ads mb must be confirmed by increasing enrollement in Nutripepa study. (Table Presented).