POS-604 MIDDLE MOLECULE CLEARANCE & EXPANDED DIALYSIS: WHAT IS THE IMPACT ON PATIENT-REPORTED SYMPTOM BURDE, THROUGH THE LENS OF THE LONDON EVALUATION OF ILLNESS (LEVIL)

Abstract

Traditionally used high flux (HF) dialyzers are incapable of clearing toxins of larger middle molecular weight, which are mainly responsible for chronic systemic inflammation, cardiovascular adversity, and poor clinical outcomes in the hemodialysis (HD) population. The recent advent of medium cut-off dialyzers (MCO)–termed expanded dialysis (HDx), have been proven to clear these hard-to-reach toxins while selectively retaining valuable proteins–a step in the right direction as we strive to improve patient care. However, there is no literature focusing on the direct impact of HDx on patient-reported symptoms and quality of life (QoL); a mortality risk in itself. Historically used cross-sectional QoL and symptom measurement tools are unable to properly assess and track the variabilities of symptom burden and are not responsive to short-term changes. The London Evaluation of Illness (LEVIL) is a patient-reported symptoms measurement tool meant for iterative use, and captures fluctuations in real-time. Symptom domains measured by LEVIL include general well-being, energy, sleep quality, bodily pain, appetite, and breathing; domains relevant to the chronic kidney disease population. We report on the impact of 12 weeks of HDx therapy on symptom burden and QoL in patients undergoing conventional HD, measured by LEVIL. A single-centred interventional pilot study in the prevalent chronic HD population-London Health Sciences Centre where 22 participants completed the study. The study was 14 weeks in length; the first 2 weeks patients completed the LEVIL questionnaire with each dialysis session using their HF dialyzer to establish baseline symptom scores. Patients were then changed to Theranova (Baxter–MCO dialyzer) for 12-weeks, continuing the complete LEVIL with each HD session. Bloodwork for CBC, lytes, urea, Cr, Ca, Phos, Alb, CRP, B2M, Free-Light-Chains (FLC) were drawn at the beginning and end of the study. Baseline results were stratified into two groups. Those with an average baseline LEVIL score (scale of 0=poor, 100=excellent) of 70 or above were grouped as “HIGH baseline,” while those with a LEVIL score of <70 were labeled “LOW baseline.” When all six symptom domains were combined, resulting in an “overall” QoL score, 73% of patients had a LOW baseline score (mean 51.5±10.2). There was a significant improvement in overall QoL in this group after 8 (mean 64.6±16.2, p=0.0013) and 12 weeks of HDx therapy (mean 67.2±16.6, p=0.0001). There was no impact on overall QoL in those with a HIGH baseline score. There were no significant differences in lab values other than a reduction of FLC in both groups, most significantly in Kappa-FLC in those with LOW baseline scores (p=0.0182). Domain-specific results also showed that patients with LOW baseline scores benefited after 8 weeks of therapy in the domains of general well-being (p=0.0008) and energy (p=0.0011). Sleep quality improved after just 4 weeks of therapy (p=0.0098). HDx improves QoL and symptom burden in those with LOW baseline LEVIL scores, significantly impacting general well-being, energy, and sleep quality. LEVIL can identify patients who may benefit from HDx and proves to capture the response to treatment after 8 weeks in the domains that most significantly impact HD patients’ QoL. Could this be the ‘magic wand’ to improve patient care?