MO907: Predictors of Negative Outcomes in HDF-OL Patients: A Cohort Study

Abstract

BACKGROUND AND AIMSHaemodiafiltration on-line (HDF-ol), an effective mode of replacement therapy for stage 5 chronic kidney disease (CKD 5D), cannot be considered sufficiently studied in terms of its effect on the outcomes. Our main aim was to identify a possible association between individual anthropometric, laboratory data and parameters of the prescribed treatment regimen with the best survival rate when using the HDF-ol mode.METHODA retrospective1 year analysis of the EuCliD database of 9986 patients treated with HDF-ol in 27 Fresenius Medical Care centres in Russia was carried out. All patients got post-dilution HDF-ol procedures at least 3 times a week, for at least 12 h a week with Kt/V at least 1.4. Data on alive (9616) and deceased (370) patients were compared by gender, age, treatment experience, body weight (BW), body mass index (BMI), body surface area (BSA), total body water volume (TBW), volume of urea distribution (V Urea BCM), presence of diabetes mellitus (DM), ischemic heart disease (CHD), chronic heart failure (CHF), as well as parameters of the procedure: effective weekly dialysis time, Kt/V, effective infusion volume (EIV) and effective convection volume (ECV).RESULTSDifferences in groups were found only for a part of parameters (Table 1).Table 1.Group of patientsStatisticAliveDeceasedP-valueBasic demographic characteristicsSex: f n (%)4422 (46.0%)140 (37.8%).0024Sex: m n (%)5194 (54.0%)230 (62.2%).0024Age (years) N 9616370<.0001Mean (SD)53.4 (13.6)58.8 (12.1)Median5560Min–max17.0–86.030.0–83.095% CI53.1–53.757.5–60.0BW (kg) N 9616370<.0001Mean (SD)75.2 (17.5)71.7 (16.5)Median73.470Min–max30.6–194.635.3–133.295% CI74.8–75.570.0–73.4BMIMean (SD)26.7 (5.7)25.5 (5.7)<.0001Median2625Min–max14.1–53.213.4–47.295% CI26.6–26.924.9–26.1CHD: yes n (%)1565 (16.3%)98 (26.5%)<.0001CHD: no n (%)8051 (83.7%)272 (73.5%)<.0001HF: yes n (%)1878 (19.5%)94 (25.4%).0065HF: no n (%)7738 (80.5%)276 (74.6%).0065diabetes: yes n (%)1213 (12.6%)72 (19.5%).0002diabetes: no n (%)8403 (87.4%)298 (80.5%).0002Parameters of the HDF ol proceduresEffective week dialysis time (min)Mean (SD)784.2 (140.2)731.6 (372.2)<.0001Median790733,5Min–max150.0–4979.0197.0–4017.095% CI781.3–787.1689.6–773.6EIV (L)Mean (SD)24.6 (4.3)23.0 (4.7)<.0001Median23.722.4Min–max0.5–69.41.9–43.895% CI24.5–24.722.6–23.5ECV (L)Mean (SD)27.0 (4.4)25.3 (5.0)<.0001Median2624.7Min–max0.5–71.22.0–46.095% CI26.9–27.124.8–25.8OCM Kt/VMean (SD)1.7 (0.3)1.7 (0.3)<.0001Median1.71.6Min–max0.5–6.40.7–3.095% CI1.7–1.71.7–1.7The main laboratory parametersCalcium (mmol/L)Mean (SD)2.2 (0.2)2.3 (0.2)<.0001Median2.22.2Min–max1.0–3.71.5–3.095% CI2.2–2.22.2–2.3Albumin (g/L)Mean (SD)40.6 (3.2)38.7 (4.3)<.0001Median4139Min–max13.0–71.018.2–49.095% CI40.5–40.638.4–38.9b2-microglobulin (mg/L)Mean (SD)23.8 (7.0)25.2 (8.1)<.0001Median23.323.7Min–max1.5–80.05.4–85.195% CI23.8–23.924.7–25.7Haemoglobin (g/L)Mean (SD)110.4 (14.9)105.6 (17.9)<.0001Median111106Min–max12.0–176.034.0–167.095% CI110.2–110.5104.5-106.7CRP (mg/L)Mean (SD)7.8 (15.7)19.7 (43.3)<.0001Median3.46.6Min–max0.0–500.00.1–521.195% CI7.6–7.917.0–22.4Table 2.Hospitalization of ESKD patients before and after the onset of the COVID-19 pandemic in a tertiary University Hospital of Thessaloniki, GreeceBefore COVID-19 pandemicAfter COVID-19 pandemicP-valueTime period1 March 2019–29 February 20211 March 2020–28 February 2021-Hospitalizationsa (n)14990-Age (years)67.7 ± 13.665.3 ± 16.7247Gender (M/F)105/44 (70.5%/29.5%)62/28 (68.9%/31.1%)884Duration of hospitalization (days)7 (2–83)9 (2–67)0.423Outcome (n, %)0.837 Improvement127 (85.2%)76 (84.4%) Stable medical condition10 (6.7%)6 (6.7%) In-hospital death12 (8.1%)8 (8.9%) aHospitalizations due to SARS-CoV-2 infection over the pandemic period were not included in this comparative analysis.CONCLUSIONAssociation of risk of death in patients with CKD 5D treated with HDF-ol included male gender, older age, concomitant diseases (CHD, CHF, DM), lower BW and BMI, shorter effective weekly dialysis time, lower values of EIV and ECV, Kt/V, higher values of hypercalcemia, hypoalbuminemia, lower haemoglobin levels, higher levels of b2-microglobulin and CRP. Such indicators as TBW, VUrea BCM, BSA and the length of treatment on dialysis did not reached statistical significance when comparing alivе and deceased patients.