MO935: A Propensity-Matched Study of The Effect of Short Daily Home Haemodialysis With Low Flow Dialysate on Nutritional Status and Body Composition

Abstract

Abstract BACKGROUND AND AIMS The present study tested the hypothesis that short daily home haemodilaysis (HDD) with low flow dialysate using the NxStage monitor (Fresenius Medical Care) could preserve muscle mass and prevent protein-energy wasting in HD patients, despite using low-flux, lactate-buffered dialysate. METHOD This 12-month, prospective, controlled study examined 25 consecutive, non-selected CKD stage 5 patients who initiated short daily HHD with low-flow dialysate (HHD group) in our centre, and were compared with data from 50 patients on high-flux HD (HF-HD group) and 50 patients on on-line haemodiafiltration (OL-HDF group) obtained from the Fresenius Medical Care clinical database EuCliD after matching for clinical characteristics and propensity scores. Changes in body composition were assessed by whole-body bioimpedance spectroscopy (BIS; Fresenius Medical Care) at baseline, months 3, 6 and 12, by experienced research staff blinded to all clinical and biochemical data of the patients. In order to control for potential variability and the effect of overhydration, all BIS analyses were performed before a mid-week dialysis session. Linear mixed-effects models were used for the analysis of the repeated measures data. RESULTS Compared with in centre HF-HD, patients assigned to HHD experienced a gradual improvement in LTM. These differences reached statistical significance at Month 6 and Month 12, with a relative difference of 2.76 kg [95% confidence interval (95% CI): 0.53–4.99; P = 0.01] and 3.08 kg (95% CI: 0.68–5.45; P = 0.01), respectively. Changes in fat inversely mirrored those of LTM, with a relative difference between groups of –3.29 kg (95% CI: –6.66–0.07; P = 0.05) at Month 12. No differences in hydration status or dry weight were noted between groups (Table 1). No significant changes in body composition were observed between the HDD and the OL-HDF groups (data not shown). CONCLUSION Short daily HHD with the NxStage system for 1 year compared with HF-HD increased muscle mass, supporting the hypothesis that short daily HHD with low-flow dialysate could benefit nutritional status and prevent protein-energy wasting in HD patients.