MON-098 Losses of Amino Acid in the Pre- and Post-dilution of On-line HDF under the Same Reduction Rate of β2-microglobulin

Abstract

We reported that amino acid loss occurred during pre-dilution on-line hemodiafiltration (Pre-HDF) was significantly less than those of hemodialysis. Since the amino acid kinetics during HDF therapy has not clearly been understood, we compared the amino acid losses that occur on performing Pre-HDF and post-dilution on-line HDF (Post-HDF) under the same reduction rate of β2-microglobulin (β2-MG) in the present study. We compared the total amino acid, total non-essential/essential/branched-chain amino acid amount into the total waste fluid, reduction rate of Urea, Cr and β2-MG and Kt/V (urea) between 9 patients undergoing Pre-HDF (7 males, 4 diabetic, mean age: 72.4±2.1 years) and the same patients receiving Post-HDF. The mean blood flow rate in the former and latter was 222±25 and 200±0 mL/min, respectively. The dialysate flow rate was 329±49 and 556±0 mL/min, respectively. The replacement fluid flow rate was 251±27 and 44±0 mL/min, respectively. The replacement fluid volume was 57±6 and 10±0 L, respectively. The reduction rate ofβ2-MG was same between the Pre-HDF and Post-HDF group (Pre-HDF: 80.9±4.0%, Post-HDF: 80.4±3.7%, P=0.545). In the Pre-HDF group, the total and total non-essential amino acid losses (4814.3±1055.6 and 3058.4±632.0 mg, respectively) were not significantly different from in the Post-HDF group (5257.3±698.9 and 3421.9±446.8 mg, respectively) (P=0.180 and 0.116, respectively). In the former, the total essential amino acid (1755.9±503.3 mg) was not significantly different from in the latter (1835.3±351.0 mg) (P=0.401) and also in the former, the branched-chain amino acid (780.2±224.2 mg) was not significantly in the latter (816.4±210.1 mg) (P=0.139). In the Pre-HDF group, the urea and Cr reduction rates were 69.5±7.4 and 63.2±6.7%, respectively. In the Post-HDF group, the values were 70.9±4.4 and 64.8±3.9%, respectively. The values showed no significant differences between the Pre-HDF and Post-HDF group (Urea: P=0.354, Cr: P=0.309). The Kt/V (urea) values in the former and latter were 1.46±0.28 and 1.45±0.19, respectively; there was no significant difference (p=0.862). Under the same reduction rate of β2-MG, the moderate volume Post-HDF (replacement fluid volume: around 10.0 L) is as favorable as the Pre-HDF as a blood purification method from the viewpoint of nutrition.