SP463
A CONVECTIVE DAILY HOME DIALYSIS PROGRAM DEVELOPMENT: PRELIMINARY OUTCOMES

INTRODUCTION AND AIMS: Retrospective studies and RCTrials recently published suggest that high-efficiency HDF may reduce the risk of mortality compared to standard hemodialysis. One of the explanations could be the higher removal of high-molecular weight uremic toxins. These molecules could be involved in the cardiovascular disease pathway. On this basis we compared the performance of a Self-Convective Daily Dialysis system (SeCoHD) compared to what can be observed in conventional techniques. The French Home Dialysis System ( Physidia® S³)combines adaptable diffusive- and convective strategies.

METHODS: We started the HHD program in February 2015 after opening our "Specific Training Unit" and we opted for the French Convective S³ System considering our past strong involvement in the development of Convective therapies since the early 90’s. Since the beginning of the program we included 13 patients. All the patients, 10 males and 3 females (53.7 +/- 13.4 y o), except three of them were incident patients. From October 2016 to October 2017, we collected all monthly blood test results as compared to our standard in-center dialysis population. Simultaneously, we ran a preliminary clinical trial to compare the common uremic toxin removal rate using variable convective volumes during the dialysis sessions.

RESULTS: Hemoglobin level was 115 +/- 13 Gr/L, with an average CERA dose of 2.7 µG/kg/month are comparable to the level in our in-center dialysis population. Pre-dialysis Phosphate blood level 1.73 +/- 0.51 mMol/L, Calcium 2.20 +/- 0.16 mMol/L. Pre-dialysis urea blood level was 22.4 +/- 7.10 mMol/L and beta2microglobulin 21.4 +/- 5.5 Gr/L. In addition, using four convective strategies (pure diffusion, 3000, 6000 and 9000 ml of convection per session) we compared the low-molecular weight uremic toxin removal rate and the high-molecular weight uremic toxin removal rate at each convective level (Dialysis time 120 mn, Blood Flow 300 ml/mn and dialysis flow 180 ml/mn). Urea removal rate was 40 %, creatinine 45 % and did not depend of the convective volume. On the other hand, phosphate removal rate was 30 % on diffusion procedure compared to 40% with a 9000 ml convective volume. Beta2microglobuline removal rate (Bergström formula) was 50% and increases at the highest convective volume. However, myoglobin removal rate was not higher than 25 %.Compared to our results on high efficiency OlHDF using the same membranes and surfaces, the removal rate of urea is 75% and the beta2microglobuline removal rate 82 % ( Blood flow 400 ml/mn, Dialysis Time 240 mn, Convective post-dilution volume 24 liters). These preliminary results obtained by using a Self-Convective Daily Dialysis System (SeCoHD) seems to be very promising. . Even if our results are preliminary, considering the low patients number included and the short follow-up period, they seem very close to those observed using the standard procedures, taking into consideration the short dialysis session time. The differences should be compensated by the daily dialysis frequency. However, further clinical trials should be run to assert the efficacy of the procedure.

CONCLUSIONS: Our first results, on a one-year follow-up of this cohort of 13 patients are herewith presented including biological and clinical outcomes. At this time, 7 patients have been successfully transplanted and one is back to the center because he lost the assisting person at home. These preliminary promising results should be confirmed by a larger cohort follow-up in the upcoming months compared to standard in-center dialysis populations. In addition, these new techniques should be evaluated in terms of cost-saving versus other methods.