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S 04 Parallel session
S 04 Haemodialysis
Saal 1, 27th September 2015, 9:00 – 10:30
Programme of the session:
GS: Przemyslaw Rutkowski (Poland)
Renal replacement therapy - the past and the future
O 01
Nocturnal home haemodialysis can reduce medication requirements
Gokce Kaya Akay (Turkey)
O 02
Aging of people: the older person in dialysis
Christina Mamone (Italy)
O 03
Variation of residual urine and the estimated glomelural filtration rate in chronic haemodialysis patients
Eva Nagy (Hungary)
O 04
Dialysis with blood volume controlled ultrafiltration - Clinical experiences
Joaquim Cardoso (Portugal)
Abstracts
GUEST SPEAKER
Renal replacement therapy – the past and the future
P. Rutkowski
Abstract is not available
BIOGRAPHY OF THE GUEST SPEAKER
O 01
Nocturnal home haemodialysis can reduce medication requirements
G. Kaya Akay1, S. Cicek2, E. Badak3, S. Tas1, H. Aykut4, C. Ceylan5, E. Unal6, S. Erten2, C. Demirci1
1Ege Nefroloji Dialysis Center, Fresenius Medical Care Turkey, Izmir, Turkey; 2Sevgi Dialysis Center, Fresenius Medical Care Turkey, Izmir, Turkey; 3Karşıyaka Dialysis Center, Fresenius Medical Care Turkey, Izmir, Turkey; 4Akhisar Dialysis Center, Fresenius Medical Care Turkey, Manisa, Turkey; 5İstanbul Dialysis Center, Fresenius Medical Care Turkey, Istanbul, Turkey; 6NephroCare Head Quarter, Fresenius Medical Care Turkey, Istanbul, Turkey
Background: Haemodialysis patients have complex medication regimens, associated with medication-related problems, non-adherence and high treatment cost.
Objectives: The aim of this study is compare the medication requirement for anaemia and mineral metabolism management between patients on conventional haemodialysis (CHD) and patients on nocturnal home haemodialysis (NHHD).
Methods: 83 patients from seven dialysis clinics who started NHHD between August 2010 and April 2014 and 83 propensity score-matched control patients who remained on CHD (3x4 hours/week) were enrolled in the study. All NHHD patients received 7-8 hours haemodialysis three-times weekly. Laboratory and medication data were collected at the beginning of home haemodialysis and after 6 and 12 months in NHHD patients and at the same time-points in control cases, respectively. Data were evaluated by means of Mc Nemar and paired t-tests.
Results: There were no differences in baseline characteristics between both cohorts, including haemoglobin concentration, transferrin saturation, ferritin, use of erythropoietin and iron, phosphate, calcium, parathormon, use of phosphate-binders and vitamin D.
In the NHHD group the proportion of patients on erythropoietin decreased from 57.3% to 23.5% (p<0.001), phosphate-binders from 86.5% to 26.4% (p<0.001), vitamin D from 52.9% to 20.5% (p=0.01) after 12 months. Haemoglobin levels remained stable (11.1±1.4 and 11.0±1.4 g/dl), phosphate level decreased from 5.0±1.3 mg/dl to 4.4±1.5 mg/dl (p=0.009). Other related parameters remained the same.
In the control group, all evaluated parameters did not change, except for phosphate which increased from 4.8±1.4 mg/dl to 5.2±1.2 mg/dl, p=0.04).
Conclusion/Application to practice: NHHD significantly reduced the need for erythropoietin, phosphate-binders and vitamin D; the mean haemoglobin remained stable and mean phosphate levels decreased.
Disclosure: No conflict of interest declared
BIOGRAPHY OF THE GUEST SPEAKER
O 02
Aging of people: the older person in dialysis
C. Mamone1, P. Priori1, M. Pendenza1, L. Di Meo1
1ASL Roma H, U.O.C. Nephrology and Dialysys S. Giuseppe Hospital, Albano Laziale (Roma), Italy
Background: The Italian population has a greater life expectancy and this leads to an aging population. The number of so-called older elderly (people aged> 75 years) is significantly increased with consequent fragility understood as a syndrome that includes the loss of functional domains (physical, psychological, social) which leads to a greater complexity of care.
Objectives: Verify whether in our dialysis center the percentage of older people is increased with associated complexity of care for frail patients. Methods: Retrospective study examines patient accidents from 2003 to 2013. The selection criteria were: age> 75 years, fragility / dependence evaluated under extreme disability (ischemic cardiomyopathy, heart failure, diabetes, peripheral vascular disease, mental faculties greatly deteriorated, inability to independently perform activities of daily living such as ambulation).
Analysis for 2014 is in progress.
Results: Deaths at 6 months of starting dialysis of older people were about 25% broken down as follows: 24% frail elderly, 1% very old died from cardiovascular causes.
Conclusion/Application to practice: In those who died fragility increased compared to those due to cardiovascular causes. The number of older people on dialysis has increased considerably becoming prevalent in our center. That increases the complexity of care due to the syndrome of frailty associated with aging. A therapeutic approach that involves more figures (neurologist, geriatrician, nurse, psychologist, social assistance) can prevent frailty syndrome.
Disclosure: No conflict of interest declared
O 03
Variation of residual urine and the estimated glomelural filtration rate in chronic haemodialysis patients
E. Nagy1, T. Csitkovics Toth1, I. Kulcsar1
1B. Braun Avitum Hungary cPlc. Dialysis Centre No. 6, Szombathely, Hungary
Background: Previously we studied variation of residual urine (Ures) and eGFR in our PD patients. We reported our results in 2014 on EDTNA Riga, and ISPD Madrid.
Objectives: The aim of this study was to analyse the variation of residual urine (Ures) and eGFR in our haemodialysis (HD) patients.
Methods: This is a retrospective cohort study: of 177 HD patients in program in Dec.31. 2014. Female:male – 91:86. We studied our patients demographic data, changes of Ures and eGFR (MDRD formula) from Jan.1 2009.
Results: Average age at the starting of HD was 61,3±13,9 ys (21,9-87,2). Average time in dialysis (following period) was 1870±1536 days (5,1±4,2 ys). 55,4% of the patients spent more then 5 years in dialysis program. 46,3% of patients was oligo-anuric (Ures<500 mL/24h) at the first HD. Till the end of the observation period this ratio increased to 77,4%. The average daily urine output at the beginning of the study was 1090 mL, but at the end of it only 580 mL. The measure of decrease is 510 mL that 100 mL/year!). The average eGFR at beginning was 9,8 mL/min/1,73 m2 and 8,5 mL/min/1,73 m2 at the end. So the average eGFR declination wasn’t significant, and it wasn’t consistent. We realized decrease in 65,8% but eGFR didn’t change in 35,2%.
Conclusion/Application to practice: The results of our study were astonishing. The Ures in this long observation period declined only 100 mL/year. In this time the anuric patient ratio increased with 31,1%. The average eGFR fall was low.
Disclosure: No conflict of interest declared
O 04
Dialysis with blood volume controlled ultrafiltration - Clinical experiences
J. Cardoso1, B. Pinto2, R. Cambim1, J. Ramalhinho1, D. Cordeiro1, A. Pernas1, R. Peralta2, J. Fazendeiro Matos2
1NephroCare Evora, Fresenius Medical Care, Evora, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal
Background: Episodes of intradialytic hypotension (IDH) are often associated with hypovolaemia due to inappropriate ultrafiltration rates during haemodialysis sessions. They affect dialysis patients with an incidence of approximately 20 to 30% of all treatments. Older and diabetic patients are more susceptible to suffer from IDH. Individualised blood volume dependent control of the ultrafiltration rate prevents excessive fluid removal adapting fluid removal to the patient´s individual tolerance.
Objectives: To assess the importance of individualised blood volume dependent control of the ultrafiltration rate for the reduction of IDH episodes.
Methods: The study included hypotension susceptible patients on haemodialysis by means of individualised blood volume controled utrafiltration for more than 6 months. For this programme, patients having IDH episodes in more than 35% of treatments for 4 weeks were selected.
Results: We analysed data available in November 2014 comparing patients (35) receiving individualised blood volume dependent control of the ultrafiltration rate during haemodialysis sessions with the remaining haemodialysis (112) population of the clinic:
• Mean Age: 76.9 vs 71.9;
• Mean Charlson Comorbidity Index score (age adjusted): 6.8 vs 6.2;
• Inter HD weight gain (IDW): 4.31 vs 3.84 kg;
• IDH episodes per 100 treatments: 3.74 vs 5.34;
• Comparing mortality rate in our unit with the Portuguese haemodialysis population in 2013
we observed a lower value: 7.20% vs 13.18%
Conclusion/Application to practice: Individualised blood volume dependent control of the ultrafiltration rate proved to be beneficial, since this treatment group reported less IDH events despite having more comorbidities and being elder as compared to the remaining haemodialysis patients.
Disclosure: No conflict of interest declared