Abstract

Background and Aims

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.

Method

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.

Results

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)

Conclusion

Expanded hemodialysis seems to allow diminishing Qd rate without changes in mid-size molecules clearance.

Table 1.

Demographic data

Qd 400 (n 11)Qd 500 (n 12)p
Age (Median; SD) years old64.92 +-13.2055.93 +- 12.810.0364 *
Male gender (N; %)54.55 (6)50.00 (6)0.579 **
ESRD aetiology (N; %)
Hypertension63.64 (7)75.00 (9)0.438**
Diabetes9.09 (1)25.00 (3)
Autoimmune disease9.09 (1).
Obstructive disease9.09 (1).
Idiopatic (unknown)9.09 (1).
Time on therapy (Months)130.94 +-89.1772.56 +- 62.980.0564*
Urine Output
< 100 ml/d90.91 (10)75.00 (9)1**
100 to 400 ml/d.8.33 (1)
> 400 ml/d9.09 (1)16.67 (2)
Dry weight (Median; SD) Kg53.36 +-7.6060.41 +- 6.720.0266*
Vascular access (N; %)
AV Fistula72.73 (8)91.67 (11)0.261**
HD Catheter27.27 (3)8.33 (1)
Ultrafiltration (Median; SD) Lts2.00 +- 0.841.63 +- 0.760.242*
Urea distribution volume (Median; SD) Lts32.41 +- 5.1932.77 +- 4.30.7818*
Qd 400 (n 11)Qd 500 (n 12)p
Age (Median; SD) years old64.92 +-13.2055.93 +- 12.810.0364 *
Male gender (N; %)54.55 (6)50.00 (6)0.579 **
ESRD aetiology (N; %)
Hypertension63.64 (7)75.00 (9)0.438**
Diabetes9.09 (1)25.00 (3)
Autoimmune disease9.09 (1).
Obstructive disease9.09 (1).
Idiopatic (unknown)9.09 (1).
Time on therapy (Months)130.94 +-89.1772.56 +- 62.980.0564*
Urine Output
< 100 ml/d90.91 (10)75.00 (9)1**
100 to 400 ml/d.8.33 (1)
> 400 ml/d9.09 (1)16.67 (2)
Dry weight (Median; SD) Kg53.36 +-7.6060.41 +- 6.720.0266*
Vascular access (N; %)
AV Fistula72.73 (8)91.67 (11)0.261**
HD Catheter27.27 (3)8.33 (1)
Ultrafiltration (Median; SD) Lts2.00 +- 0.841.63 +- 0.760.242*
Urea distribution volume (Median; SD) Lts32.41 +- 5.1932.77 +- 4.30.7818*
*

U Mann Whitney;

**

Fisher test

Table 1.

Demographic data

Qd 400 (n 11)Qd 500 (n 12)p
Age (Median; SD) years old64.92 +-13.2055.93 +- 12.810.0364 *
Male gender (N; %)54.55 (6)50.00 (6)0.579 **
ESRD aetiology (N; %)
Hypertension63.64 (7)75.00 (9)0.438**
Diabetes9.09 (1)25.00 (3)
Autoimmune disease9.09 (1).
Obstructive disease9.09 (1).
Idiopatic (unknown)9.09 (1).
Time on therapy (Months)130.94 +-89.1772.56 +- 62.980.0564*
Urine Output
< 100 ml/d90.91 (10)75.00 (9)1**
100 to 400 ml/d.8.33 (1)
> 400 ml/d9.09 (1)16.67 (2)
Dry weight (Median; SD) Kg53.36 +-7.6060.41 +- 6.720.0266*
Vascular access (N; %)
AV Fistula72.73 (8)91.67 (11)0.261**
HD Catheter27.27 (3)8.33 (1)
Ultrafiltration (Median; SD) Lts2.00 +- 0.841.63 +- 0.760.242*
Urea distribution volume (Median; SD) Lts32.41 +- 5.1932.77 +- 4.30.7818*
Qd 400 (n 11)Qd 500 (n 12)p
Age (Median; SD) years old64.92 +-13.2055.93 +- 12.810.0364 *
Male gender (N; %)54.55 (6)50.00 (6)0.579 **
ESRD aetiology (N; %)
Hypertension63.64 (7)75.00 (9)0.438**
Diabetes9.09 (1)25.00 (3)
Autoimmune disease9.09 (1).
Obstructive disease9.09 (1).
Idiopatic (unknown)9.09 (1).
Time on therapy (Months)130.94 +-89.1772.56 +- 62.980.0564*
Urine Output
< 100 ml/d90.91 (10)75.00 (9)1**
100 to 400 ml/d.8.33 (1)
> 400 ml/d9.09 (1)16.67 (2)
Dry weight (Median; SD) Kg53.36 +-7.6060.41 +- 6.720.0266*
Vascular access (N; %)
AV Fistula72.73 (8)91.67 (11)0.261**
HD Catheter27.27 (3)8.33 (1)
Ultrafiltration (Median; SD) Lts2.00 +- 0.841.63 +- 0.760.242*
Urea distribution volume (Median; SD) Lts32.41 +- 5.1932.77 +- 4.30.7818*
*

U Mann Whitney;

**

Fisher test

Table 2.

Middle size molecules clearance

MoleculeQd 400 (n11)Qd 500 (n12)p- Value*
Beta-2 microglobuline pre mg/L (Media; SD)24.26 +- 9.2821.69 +- 8.520,497
Beta-2 microglobuline post mg/L (Media;SD)9.42 +- 11.567.19 +- 3.020,527
Aclaramiento Beta-2 microglobuline (Media;SD)14.84 +- 16.6214.50 +- 7.200,949
Interleukin 6 pre pg/mL (Media; SD)5.49 +- 2.299.44 +- 3.960,009
Interleukin 6 post pg/mL (Media; SD)8.66 +- 11.119.93 +- 4.110,715
Interleukin 6 clearance (Media;SD)1.91 +- 0.891.61 +- 0 .760,410
Lambda pre mg/L (Media; SD)183.5 +- 144.44157.00 +- 55.120,561
Lambda post mg/L (Media; SD)115.93 +- 106.9497.28 +- 38.240,577
Lambda Clearance (Media; SD)2.77 +- 1.152.10 +- 0.950,142
Kappa pre mg/L (Media; SD)378.04 +- 343.94222.26 +- 106.630,150
Kappa post mg/L (Media; SD)78.42 +- 49.5577.44 +- 36.740,957
Kappa clearance (Media; SD)2.17 +- 0.811.85 +- 0.850,367
MoleculeQd 400 (n11)Qd 500 (n12)p- Value*
Beta-2 microglobuline pre mg/L (Media; SD)24.26 +- 9.2821.69 +- 8.520,497
Beta-2 microglobuline post mg/L (Media;SD)9.42 +- 11.567.19 +- 3.020,527
Aclaramiento Beta-2 microglobuline (Media;SD)14.84 +- 16.6214.50 +- 7.200,949
Interleukin 6 pre pg/mL (Media; SD)5.49 +- 2.299.44 +- 3.960,009
Interleukin 6 post pg/mL (Media; SD)8.66 +- 11.119.93 +- 4.110,715
Interleukin 6 clearance (Media;SD)1.91 +- 0.891.61 +- 0 .760,410
Lambda pre mg/L (Media; SD)183.5 +- 144.44157.00 +- 55.120,561
Lambda post mg/L (Media; SD)115.93 +- 106.9497.28 +- 38.240,577
Lambda Clearance (Media; SD)2.77 +- 1.152.10 +- 0.950,142
Kappa pre mg/L (Media; SD)378.04 +- 343.94222.26 +- 106.630,150
Kappa post mg/L (Media; SD)78.42 +- 49.5577.44 +- 36.740,957
Kappa clearance (Media; SD)2.17 +- 0.811.85 +- 0.850,367
*

Student Test

Table 2.

Middle size molecules clearance

MoleculeQd 400 (n11)Qd 500 (n12)p- Value*
Beta-2 microglobuline pre mg/L (Media; SD)24.26 +- 9.2821.69 +- 8.520,497
Beta-2 microglobuline post mg/L (Media;SD)9.42 +- 11.567.19 +- 3.020,527
Aclaramiento Beta-2 microglobuline (Media;SD)14.84 +- 16.6214.50 +- 7.200,949
Interleukin 6 pre pg/mL (Media; SD)5.49 +- 2.299.44 +- 3.960,009
Interleukin 6 post pg/mL (Media; SD)8.66 +- 11.119.93 +- 4.110,715
Interleukin 6 clearance (Media;SD)1.91 +- 0.891.61 +- 0 .760,410
Lambda pre mg/L (Media; SD)183.5 +- 144.44157.00 +- 55.120,561
Lambda post mg/L (Media; SD)115.93 +- 106.9497.28 +- 38.240,577
Lambda Clearance (Media; SD)2.77 +- 1.152.10 +- 0.950,142
Kappa pre mg/L (Media; SD)378.04 +- 343.94222.26 +- 106.630,150
Kappa post mg/L (Media; SD)78.42 +- 49.5577.44 +- 36.740,957
Kappa clearance (Media; SD)2.17 +- 0.811.85 +- 0.850,367
MoleculeQd 400 (n11)Qd 500 (n12)p- Value*
Beta-2 microglobuline pre mg/L (Media; SD)24.26 +- 9.2821.69 +- 8.520,497
Beta-2 microglobuline post mg/L (Media;SD)9.42 +- 11.567.19 +- 3.020,527
Aclaramiento Beta-2 microglobuline (Media;SD)14.84 +- 16.6214.50 +- 7.200,949
Interleukin 6 pre pg/mL (Media; SD)5.49 +- 2.299.44 +- 3.960,009
Interleukin 6 post pg/mL (Media; SD)8.66 +- 11.119.93 +- 4.110,715
Interleukin 6 clearance (Media;SD)1.91 +- 0.891.61 +- 0 .760,410
Lambda pre mg/L (Media; SD)183.5 +- 144.44157.00 +- 55.120,561
Lambda post mg/L (Media; SD)115.93 +- 106.9497.28 +- 38.240,577
Lambda Clearance (Media; SD)2.77 +- 1.152.10 +- 0.950,142
Kappa pre mg/L (Media; SD)378.04 +- 343.94222.26 +- 106.630,150
Kappa post mg/L (Media; SD)78.42 +- 49.5577.44 +- 36.740,957
Kappa clearance (Media; SD)2.17 +- 0.811.85 +- 0.850,367
*

Student Test

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