B JOSPEH1, H KULKARNI1
1East Metro Health Services – Armadale Health Services, Armadale, Australia
Aim: To study the effectiveness of m-HDF in the haemodialysis (HD) population who achieve less than adequate substitution volumes with p-HDF.
Background: m- HDF offers improved small and middle molecule clearance compared to p-HDF in patients who do not achieve substitution volumes of 23 litres with p-HDF. This is yet to be proven.
Methods: Prospective cross over sequential study was conducted in an outer-metropolitan dialysis unit in eligible adult patients (> 3 months on maintenance HD via p- HDF and not achieving substitution volumes of 23 litres with p-HDF. All eligible patients underwent thrice weekly dialysis in 4-weekly intervals of p-HDF (A), m-HDF (B) and p-HDF (C) respectively. Dialysis adequacy was evaluated measuring small molecule clearance by urea reduction ratio (URR) and middle molecule clearance by Beta2 microglobulin (β2M) in the midweek dialysis session of A, B and C respectively. Secondary outcomes evaluated by comparing substitution volumes, dialysis recovery time, dialyser clotting episodes and intradialytic hypotensive episodes in A, B and C respectively.
Results: 16 patients (Age 39 – 84 years, median 61)) underwent 564 HDF sessions in 12 weeks. There was no significant difference in dialysis adequacy for m-HDF and p-HDF (URR for periods A,B and C was 76.1%, 74.1% and 75.1% respectively. β2M clearance was 79.4%, 78.4% and 78.3 % respectively). (P>0.5) There was no significant difference observed in any of the secondary outcomes.
Conclusion: m- HDF did not offer any significant benefits in clearances of urea and β2M in patients who do not achieve substitution volumes of 23 litres with p-HDF.
Boby Jospeh is Nurse Unit Manager of Armadale Dialysis Unit and almost finished Renal Nurse Practitioner Degree. Apart from being a manager, he is keen in clinical research in haemodialysis making difference to patient care.