POS-608 CLINICAL OUTCOMES OF HEMOPERFUSION USING HA130 CARTRIDGE AMONG MAINTENANCE HEMODIALYSIS PATIENTS IN ST. LUKE’S MEDICAL CENTER-QC AND GAT ANDRES MEMORIAL MEDICAL CENTER: A CROSS-SECTIONAL STUDY

Abstract

Despite the advancement in blood purification technology, the mortality rate of maintenance hemodialysis patients is still high with cardiovascular disease as the leading cause of death. This study aimed to compare the clinical outcomes of patients who underwent hemoperfusion using HA-130 cartridge with hemodialysis to those with hemodialysis alone among maintenance hemodialysis patients in St. Luke’s Medical Center Quezon City dialysis unit and Flora V Valisno De Siojo Dialysis Center of Gat Andres Bonifacio Memorial Medical Center from August 2018–May 2019. This cross-sectional study included 183 patients who underwent hemodialysis (HD) and hemoperfusion HP) using HA-130 cartridge and 156 patients on hemodialysis alone. Serum phosphorous, albumin, hemoglobin, erythropoietin(EPO) dose, Kt/V, hospitalizations, and mortality were compared from baseline, at the start and end of hemoperfusion when appropriate and between these two groups. Significant differences in baseline characteristics were: the patients in HD alone group were older (p = 0.002), predominantly had diabetic kidney disease (p = 0.002), and hemoglobin of <9.5 g/dl (p = 0.0001). While most patients in HD + HP group had hypertensive nephrosclerosis (p = 0.003), with hemoglobin 9.5 to 11.5 g/dl (p = 0.001) and >11.5 g/dl (p = 0.038). Main indication for hemoperfusion was an elevated serum phosphorous which was increased in HD + HP group (p = 0.0001). From baseline values, these variables improved after hemoperfusion: EPO dose (mean = 9448 + 3626.4 versus 10092 + 3405.6 units/week, p = 0.050, 95%CI -1286.4 to 0.95); hemoglobin (mean = 10.8 + 1.5 versus 10.5 + 1.7g/dl, p = 0.016, 95%CI 0.1 to 0.7); and albumin (mean = 3.9 + 0.5 versus 3.7 + 0.6 g/dl, p = 0.010, 95%CI 0.03 to 0.2). There was no significant difference with phosphorous (mean = 2.04 + 0.7 versus 2.08 + 0.6 mmol/L, p = 0.520, 95%CI -0.2 to 0.1) at the end of the study, although there was a significant difference in the second and third months of treatment (p = 0.0001). At the end of the study; albumin (p = 0.0001, 95%CI -0.4 to -0.03) and hemoglobin (p = 0.0004, 95%CI -1.0 to -0.3) were significantly higher in HD+HP group. The percentage of patients with hemoglobin <9.5 g/dl was significantly lower(p = 0.0001) in HD+HP group (10.9%) than in HD alone group (34.2%). Although the phosphorous in HD alone group was lower (p = 0.017, 95%CI -0.4 to -0.03) than in HD + HP group, it increased in HD alone group from baseline (mean = 1.84 + 0.70 versus 1.56 + 0.66mmol/L). There was no significant difference in EPO dose (p = NS) and Kt/V (p = NS) in both groups. Hospitalization rate OR = 4.23 (p = 0.0104, 95%CI 1.93 to 9.27) and mortality rate OR = 4.07 (p = 0.0001, 95%CI 1.30 to12.75) such that patients in HD alone group were four times more likely to be hospitalized and to die than those in HD+HP group Patients who underwent hemodialysis and hemoperfusion using HA-130 cartridge had a lower risk of hospitalization and mortality than those on hemodialysis alone. There were significant improvements in hemoglobin, erythropoietin dose, albumin, and phosphorous values from baseline in HD + HP patients.