MO661: Elimination of Middle and Large Uraemic Toxins in Short Daily Home Haemodialysis with Low Dialysate Volume: A Randomized Crossover Clinical Trial

Abstract

Abstract BACKGROUND AND AIMS Portable haemodialysis (HD) systems with a low dialysate flow rate in a short frequent schedule have become an attractive option for patients on home HD (HHD). Although these systems have been demonstrated to be effective for removing low weight molecular uraemic toxins, there are few data on their removal ability of higher molecular weight toxins. This study assessed the uraemic toxin removal ability of the portable Physidia S3 Monitor in a short, frequent, 5 days/week, low-dialysate flux HHD versus 3 days/week, in centre online haemodiafiltration (OL-HDF). METHOD In an open, randomized, cross-over, single-centre, controlled, prospective study, 40 adult chronic HD patients were treated by a 2.5-h low flux dialysate HD session or a 4-h post-dilution OL-HDF. All other dialysis parameters including dialyzer (polysulfone high-flux dialyzer NS 1.8, Toray®) were kept constant in both the study arms. The weekly reduction rate (RR) and the weekly eliminated mass into dialysate (EM) of urea, creatinine, phosphate, β2-microglobulin, kappa (κFLC) and lambda (λFLC) free light chains and albumin, were intra-individually compared for the two dialysis types with linear mixed models. RESULTS There were no significant differences in the RR for urea, phosphate, κFLC and albumin, whereas the weekly RRs for creatinine and β2-microglobulin were significantly higher with the Physidia S3 system than those obtained with OL-HDF (Table). Only the λFLC RR was significantly higher with OL-HDF. Similar results were observed when weekly EMs were compared (data not shown). CONCLUSION This study demonstrates that treating patients with low flow dialysate HHD in a short frequent schedule with Physidia S3 system, instead of 3 days/week, in-centre OL-HDF, significantly increases the weekly elimination of β2-microglobulin, enabling an adequate clearance of small and large uraemic toxins.