SP660HIGH-VOLUME ON-LINE HEMODIAFILTRATION MAY PREVENT PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS: A 1-YEAR PROSPECTIVE CONTROLLED STUDY

Abstract

INTRODUCTION AND AIMS: Compared to conventional hemodialysis (HD), online hemodiafiltration (OL‐HDF) achieves a more efficient removal of uremic toxins and reduces inflammation, which could favourably affect nutritional status. We evaluated the effect of OL‐HDF on body composition and nutritional status in prevalent high‐flux HD (HF‐HD) patients. METHODS: 33 adults with CKD stage 5 undergoing maintenance HF‐HD were quasirandomly assigned to postdilution OL‐HDF (n=17) or to remain on HF‐HD (n=16; control group) for 12 months. The primary outcome was the change in lean tissue mass (LTM), intracellular water (ICW) and body cell mass (BCM), assessed by multifrequency bioimpedance spectroscopy (BIS) at baseline, 4, 8 and 12 months. The secondary outcomes considered changes from baseline in other bioimpedanciometry parameters [fat, adipose tissue mass, total body water, extracellular water (ECW), overhydration (OH) and phase angle at 50 KHz], and serum prealbumin concentration. Additional nutritional status surrogates were albumin, transferrin, creatinine, total cholesterol, high‐sensitive C reactive protein (hs‐CRP), weight, and protein intake assessed by normalized protein appearance (nPNA).The rate of change in these parameters was estimated with linear mixed‐effects models. RESULTS: Compared with OL‐HDF, patients assigned toHF‐HDexperienced a gradual reduction in LTM, ICWand BCM. These differences reached statistical significance at month 12, with a relative difference of 7.31 kg [(95%CI:2.50 to 12.11); p=0.003], 2.32 l [(95%CI:0.63 to 4.01); p=0.008], and 5.20 kg [(95%CI:1.74 to 8.66); p=0.004] for LTM, ICWand BCM, respectively. In theHF‐HDgroup there was a relative increase in fat, which was evident atmonth 4 and remained statistically significant at months 8 and 12 (Figure). There were not significant relative changes in ECWnorOH. The phase angle increased in the treatment group compared with controls, reflecting preservation of lean body mass in the treatment group.The nPNA increased in theOL‐HDF group compared with HF‐HDgroup [0.26 g/kg/d (95%CI:0.05 to 0.47); p=0.002], with a relative reduction in hs‐CRP [‐13.31mg/dl (95%CI:‐24.63 to‐1.98); p=0.02] atmonth 12 (Figure presented). CONCLUSIONS: 1‐year of OL‐HDF, compared to HF‐HD, preserved muscle mass, increased protein intake and reduced the inflammatory state related to uremia and dialysis, supporting the hypothesis that high convection volume could benefit nutritional status and prevent protein‐energy wasting in HD patients.