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Alejandra Molano Trivino, Eduardo Zúñiga, Mauricio Sanabria, Jasmin Vesga, Carolina Ramos, Juan Felipe Gutiérrez, Ha Tran, Claudio Ronco, Angela Rivera, P1117
EXPLORATORY COMPARISON OF DIALYSIS EFFICIENCY AT DIFFERENT DIALYSATE FLOW (QD) IN EXPANDED HEMODIALYSIS IN TWO CENTERS IN COLOMBIA, Nephrology Dialysis Transplantation, Volume 35, Issue Supplement_3, June 2020, gfaa142.P1117, https://doi.org/10.1093/ndt/gfaa142.P1117 - Share Icon Share
Abstract
Dialysate flow rate (Qd) has minimal effect in removal of molecules in hemodialysis, allowing to use lower amounts of dialysate with no effect in clearance of molecules. According to recent literature, Expanded hemodialysis (HDx) improves the clearance of middle size molecules, diminishing the effect of Qd in adequacy. We found no data about clearance at different dialysate flow rates in HDx.
Our aim is to evaluate the clearance of middle molecules (beta 2 microglobuline [Mβ2], interleukin-6 [IL-6], interleukin-10 [IL-10 light chains (CLL-κ -λ) with HDx at different Qd using membranes TheranovaMR in patients with body weight less than 70 Kg.
We performed an observational retrospective analysis of clearance of Mβ2, IL-6, IL-10, CLL-κ; CLL-λ in HDx using TheranovaMR filters with Qd 400 mL/min and 500 mL/min. We performed variance analysis, T student test and Wilcoxon test. Data were extracted from an HDx multicentric trial performed in Bogotá, Colombia in 2018.
11 (47%) patients received Qd 400 mL/min and 12 (52.1%) patients with Qd 500ml/min. Demographic data are included in table 1. We found no differences in reduction rate of mid-molecules. (Table 2) We found that lower water consume in the Qd 400 mL/min group, with water savings of 24 Liters/patient (13824 L in 12 weeks of follow up). (Table 3)
Expanded hemodialysis seems to allow diminishing Qd rate without changes in mid-size molecules clearance.
. | Qd 400 (n 11) . | Qd 500 (n 12) . | p . |
---|---|---|---|
Age (Median; SD) years old . | 64.92 +-13.20 . | 55.93 +- 12.81 . | 0.0364 * . |
Male gender (N; %) | 54.55 (6) | 50.00 (6) | 0.579 ** |
ESRD aetiology (N; %) | |||
Hypertension | 63.64 (7) | 75.00 (9) | 0.438** |
Diabetes | 9.09 (1) | 25.00 (3) | |
Autoimmune disease | 9.09 (1) | . | |
Obstructive disease | 9.09 (1) | . | |
Idiopatic (unknown) | 9.09 (1) | . | |
Time on therapy (Months) | 130.94 +-89.17 | 72.56 +- 62.98 | 0.0564* |
Urine Output | |||
< 100 ml/d | 90.91 (10) | 75.00 (9) | 1** |
100 to 400 ml/d | . | 8.33 (1) | |
> 400 ml/d | 9.09 (1) | 16.67 (2) | |
Dry weight (Median; SD) Kg | 53.36 +-7.60 | 60.41 +- 6.72 | 0.0266* |
Vascular access (N; %) | |||
AV Fistula | 72.73 (8) | 91.67 (11) | 0.261** |
HD Catheter | 27.27 (3) | 8.33 (1) | |
Ultrafiltration (Median; SD) Lts | 2.00 +- 0.84 | 1.63 +- 0.76 | 0.242* |
Urea distribution volume (Median; SD) Lts | 32.41 +- 5.19 | 32.77 +- 4.3 | 0.7818* |
. | Qd 400 (n 11) . | Qd 500 (n 12) . | p . |
---|---|---|---|
Age (Median; SD) years old . | 64.92 +-13.20 . | 55.93 +- 12.81 . | 0.0364 * . |
Male gender (N; %) | 54.55 (6) | 50.00 (6) | 0.579 ** |
ESRD aetiology (N; %) | |||
Hypertension | 63.64 (7) | 75.00 (9) | 0.438** |
Diabetes | 9.09 (1) | 25.00 (3) | |
Autoimmune disease | 9.09 (1) | . | |
Obstructive disease | 9.09 (1) | . | |
Idiopatic (unknown) | 9.09 (1) | . | |
Time on therapy (Months) | 130.94 +-89.17 | 72.56 +- 62.98 | 0.0564* |
Urine Output | |||
< 100 ml/d | 90.91 (10) | 75.00 (9) | 1** |
100 to 400 ml/d | . | 8.33 (1) | |
> 400 ml/d | 9.09 (1) | 16.67 (2) | |
Dry weight (Median; SD) Kg | 53.36 +-7.60 | 60.41 +- 6.72 | 0.0266* |
Vascular access (N; %) | |||
AV Fistula | 72.73 (8) | 91.67 (11) | 0.261** |
HD Catheter | 27.27 (3) | 8.33 (1) | |
Ultrafiltration (Median; SD) Lts | 2.00 +- 0.84 | 1.63 +- 0.76 | 0.242* |
Urea distribution volume (Median; SD) Lts | 32.41 +- 5.19 | 32.77 +- 4.3 | 0.7818* |
U Mann Whitney;
Fisher test
. | Qd 400 (n 11) . | Qd 500 (n 12) . | p . |
---|---|---|---|
Age (Median; SD) years old . | 64.92 +-13.20 . | 55.93 +- 12.81 . | 0.0364 * . |
Male gender (N; %) | 54.55 (6) | 50.00 (6) | 0.579 ** |
ESRD aetiology (N; %) | |||
Hypertension | 63.64 (7) | 75.00 (9) | 0.438** |
Diabetes | 9.09 (1) | 25.00 (3) | |
Autoimmune disease | 9.09 (1) | . | |
Obstructive disease | 9.09 (1) | . | |
Idiopatic (unknown) | 9.09 (1) | . | |
Time on therapy (Months) | 130.94 +-89.17 | 72.56 +- 62.98 | 0.0564* |
Urine Output | |||
< 100 ml/d | 90.91 (10) | 75.00 (9) | 1** |
100 to 400 ml/d | . | 8.33 (1) | |
> 400 ml/d | 9.09 (1) | 16.67 (2) | |
Dry weight (Median; SD) Kg | 53.36 +-7.60 | 60.41 +- 6.72 | 0.0266* |
Vascular access (N; %) | |||
AV Fistula | 72.73 (8) | 91.67 (11) | 0.261** |
HD Catheter | 27.27 (3) | 8.33 (1) | |
Ultrafiltration (Median; SD) Lts | 2.00 +- 0.84 | 1.63 +- 0.76 | 0.242* |
Urea distribution volume (Median; SD) Lts | 32.41 +- 5.19 | 32.77 +- 4.3 | 0.7818* |
. | Qd 400 (n 11) . | Qd 500 (n 12) . | p . |
---|---|---|---|
Age (Median; SD) years old . | 64.92 +-13.20 . | 55.93 +- 12.81 . | 0.0364 * . |
Male gender (N; %) | 54.55 (6) | 50.00 (6) | 0.579 ** |
ESRD aetiology (N; %) | |||
Hypertension | 63.64 (7) | 75.00 (9) | 0.438** |
Diabetes | 9.09 (1) | 25.00 (3) | |
Autoimmune disease | 9.09 (1) | . | |
Obstructive disease | 9.09 (1) | . | |
Idiopatic (unknown) | 9.09 (1) | . | |
Time on therapy (Months) | 130.94 +-89.17 | 72.56 +- 62.98 | 0.0564* |
Urine Output | |||
< 100 ml/d | 90.91 (10) | 75.00 (9) | 1** |
100 to 400 ml/d | . | 8.33 (1) | |
> 400 ml/d | 9.09 (1) | 16.67 (2) | |
Dry weight (Median; SD) Kg | 53.36 +-7.60 | 60.41 +- 6.72 | 0.0266* |
Vascular access (N; %) | |||
AV Fistula | 72.73 (8) | 91.67 (11) | 0.261** |
HD Catheter | 27.27 (3) | 8.33 (1) | |
Ultrafiltration (Median; SD) Lts | 2.00 +- 0.84 | 1.63 +- 0.76 | 0.242* |
Urea distribution volume (Median; SD) Lts | 32.41 +- 5.19 | 32.77 +- 4.3 | 0.7818* |
U Mann Whitney;
Fisher test
Molecule . | Qd 400 (n11) . | Qd 500 (n12) . | p- Value* . |
---|---|---|---|
Beta-2 microglobuline pre mg/L (Media; SD) . | 24.26 +- 9.28 . | 21.69 +- 8.52 . | 0,497 . |
Beta-2 microglobuline post mg/L (Media;SD) | 9.42 +- 11.56 | 7.19 +- 3.02 | 0,527 |
Aclaramiento Beta-2 microglobuline (Media;SD) | 14.84 +- 16.62 | 14.50 +- 7.20 | 0,949 |
Interleukin 6 pre pg/mL (Media; SD) | 5.49 +- 2.29 | 9.44 +- 3.96 | 0,009 |
Interleukin 6 post pg/mL (Media; SD) | 8.66 +- 11.11 | 9.93 +- 4.11 | 0,715 |
Interleukin 6 clearance (Media;SD) | 1.91 +- 0.89 | 1.61 +- 0 .76 | 0,410 |
Lambda pre mg/L (Media; SD) | 183.5 +- 144.44 | 157.00 +- 55.12 | 0,561 |
Lambda post mg/L (Media; SD) | 115.93 +- 106.94 | 97.28 +- 38.24 | 0,577 |
Lambda Clearance (Media; SD) | 2.77 +- 1.15 | 2.10 +- 0.95 | 0,142 |
Kappa pre mg/L (Media; SD) | 378.04 +- 343.94 | 222.26 +- 106.63 | 0,150 |
Kappa post mg/L (Media; SD) | 78.42 +- 49.55 | 77.44 +- 36.74 | 0,957 |
Kappa clearance (Media; SD) | 2.17 +- 0.81 | 1.85 +- 0.85 | 0,367 |
Molecule . | Qd 400 (n11) . | Qd 500 (n12) . | p- Value* . |
---|---|---|---|
Beta-2 microglobuline pre mg/L (Media; SD) . | 24.26 +- 9.28 . | 21.69 +- 8.52 . | 0,497 . |
Beta-2 microglobuline post mg/L (Media;SD) | 9.42 +- 11.56 | 7.19 +- 3.02 | 0,527 |
Aclaramiento Beta-2 microglobuline (Media;SD) | 14.84 +- 16.62 | 14.50 +- 7.20 | 0,949 |
Interleukin 6 pre pg/mL (Media; SD) | 5.49 +- 2.29 | 9.44 +- 3.96 | 0,009 |
Interleukin 6 post pg/mL (Media; SD) | 8.66 +- 11.11 | 9.93 +- 4.11 | 0,715 |
Interleukin 6 clearance (Media;SD) | 1.91 +- 0.89 | 1.61 +- 0 .76 | 0,410 |
Lambda pre mg/L (Media; SD) | 183.5 +- 144.44 | 157.00 +- 55.12 | 0,561 |
Lambda post mg/L (Media; SD) | 115.93 +- 106.94 | 97.28 +- 38.24 | 0,577 |
Lambda Clearance (Media; SD) | 2.77 +- 1.15 | 2.10 +- 0.95 | 0,142 |
Kappa pre mg/L (Media; SD) | 378.04 +- 343.94 | 222.26 +- 106.63 | 0,150 |
Kappa post mg/L (Media; SD) | 78.42 +- 49.55 | 77.44 +- 36.74 | 0,957 |
Kappa clearance (Media; SD) | 2.17 +- 0.81 | 1.85 +- 0.85 | 0,367 |
Student Test
Molecule . | Qd 400 (n11) . | Qd 500 (n12) . | p- Value* . |
---|---|---|---|
Beta-2 microglobuline pre mg/L (Media; SD) . | 24.26 +- 9.28 . | 21.69 +- 8.52 . | 0,497 . |
Beta-2 microglobuline post mg/L (Media;SD) | 9.42 +- 11.56 | 7.19 +- 3.02 | 0,527 |
Aclaramiento Beta-2 microglobuline (Media;SD) | 14.84 +- 16.62 | 14.50 +- 7.20 | 0,949 |
Interleukin 6 pre pg/mL (Media; SD) | 5.49 +- 2.29 | 9.44 +- 3.96 | 0,009 |
Interleukin 6 post pg/mL (Media; SD) | 8.66 +- 11.11 | 9.93 +- 4.11 | 0,715 |
Interleukin 6 clearance (Media;SD) | 1.91 +- 0.89 | 1.61 +- 0 .76 | 0,410 |
Lambda pre mg/L (Media; SD) | 183.5 +- 144.44 | 157.00 +- 55.12 | 0,561 |
Lambda post mg/L (Media; SD) | 115.93 +- 106.94 | 97.28 +- 38.24 | 0,577 |
Lambda Clearance (Media; SD) | 2.77 +- 1.15 | 2.10 +- 0.95 | 0,142 |
Kappa pre mg/L (Media; SD) | 378.04 +- 343.94 | 222.26 +- 106.63 | 0,150 |
Kappa post mg/L (Media; SD) | 78.42 +- 49.55 | 77.44 +- 36.74 | 0,957 |
Kappa clearance (Media; SD) | 2.17 +- 0.81 | 1.85 +- 0.85 | 0,367 |
Molecule . | Qd 400 (n11) . | Qd 500 (n12) . | p- Value* . |
---|---|---|---|
Beta-2 microglobuline pre mg/L (Media; SD) . | 24.26 +- 9.28 . | 21.69 +- 8.52 . | 0,497 . |
Beta-2 microglobuline post mg/L (Media;SD) | 9.42 +- 11.56 | 7.19 +- 3.02 | 0,527 |
Aclaramiento Beta-2 microglobuline (Media;SD) | 14.84 +- 16.62 | 14.50 +- 7.20 | 0,949 |
Interleukin 6 pre pg/mL (Media; SD) | 5.49 +- 2.29 | 9.44 +- 3.96 | 0,009 |
Interleukin 6 post pg/mL (Media; SD) | 8.66 +- 11.11 | 9.93 +- 4.11 | 0,715 |
Interleukin 6 clearance (Media;SD) | 1.91 +- 0.89 | 1.61 +- 0 .76 | 0,410 |
Lambda pre mg/L (Media; SD) | 183.5 +- 144.44 | 157.00 +- 55.12 | 0,561 |
Lambda post mg/L (Media; SD) | 115.93 +- 106.94 | 97.28 +- 38.24 | 0,577 |
Lambda Clearance (Media; SD) | 2.77 +- 1.15 | 2.10 +- 0.95 | 0,142 |
Kappa pre mg/L (Media; SD) | 378.04 +- 343.94 | 222.26 +- 106.63 | 0,150 |
Kappa post mg/L (Media; SD) | 78.42 +- 49.55 | 77.44 +- 36.74 | 0,957 |
Kappa clearance (Media; SD) | 2.17 +- 0.81 | 1.85 +- 0.85 | 0,367 |
Student Test
- hypertension
- arteriovenous fistula
- hemodialysis
- diabetes mellitus
- kidney failure, chronic
- diabetes mellitus, type 2
- drug clearance
- autoimmune diseases
- colombia
- demography
- dialysis solutions
- follow-up
- interleukin-10
- male
- tissue membrane
- ultrafiltration
- interleukin-6
- urea
- urine volume
- catheters
- vascular access
- obstructive disease
- unit of flow rate
- causality
- filters
- molecule
- fluid flow
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