Menu
To return to your session overview use the "Go Back" button in your Internet browser.
S 23 Parallel session
S 23 Technical – Dialysis Adequacy
Grosser Saal, 28th September 2015, 14:00 – 15:30
Programme of the Session:
GS: Frantisek Lopot (Czech Republic)
The neglected issue of dialysis time in evolution of haemodialysis adequacy
O 58
Restitution volumes at dialysis sessions’ end: A potential influencing factor on patients' haemoglobin values?
Joao Fazendeiro Matos (Portugal)
O 59
Reduction of water consumption without effects on dialysis quality
Barış Demirel (Turkey)
O 60
Diagnostic therapeutic healthcare pathway for the management of hematologic patients admitted to nephrology department
Raffaele Longo (Italy)
O 61
Extended darbeoetin alfa dosing apparently reduced erythropoiesis stimulating agent requirement to achieve haemoglobin target
Leonilde Amado (Portugal)
Abstracts:
GUEST SPEAKER
The neglected issue of dialysis time in evolution of haemodialysis adequacy
F. Lopot1
1General University Hospital and 1st Medical Faculty of the Charles University, Prague, Czech Republic
Most current approaches and studies on haemodialysis (HD) adequacy are based on “dialysis dose”, i.e. on product of clearance and dialysis time (Td). As a matter of fact, the only randomized controlled trial stratified in such a way that impact of Td upon HD treatment outcome could have been assessed was the National Cooperative Dialysis Study (NCDS) done in the 70-ies. However, the first statistical analyses of the NCDS concluded that impact of plasma urea level was of much higher importance than that of Td. After transformation of the formal urea kinetic modelling used in the NCDS into the dialysis dose Kt/V concept, it became practically impossible to investigate Td impact separately. Following the introduction of the thrice weekly schedule instead of the previously used twice weekly one (surprisingly also without appropriately scheduled and powered studies), it was the number of HD sessions per week that became the preferred investigated adequacy parameter and the issue of Td remained widely ignored further. Yet there are several excellent theoretical studies showing that more frequent HD per se are beneficial only for solutes with rather small distribution volume while for solutes with larger distribution volume prolonged Td would be of equal or higher importance. Accounting further for the ever growing number of identified uremic toxins, it is thus time for revisal of Td roles and possibilities in HD adequacy.
BIOGRAPHY OF THE GUEST SPEAKER
O 58
Restitution volumes at dialysis sessions’ end: A potential influencing factor on patients' haemoglobin values?
J. Fazendeiro Matos1, C. Felix1, B. Pinto1, P. Gonçalves2, V. Carlos3, R. Rodrigues4, 3, R. Peralta1, P. Ponce2
1NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Lisboa, Portugal; 3EMAES, Universidade da Beira Interior, Covilhã, Portugal; 4NECE-UBI, Universidade da Beira Interior, Covilhã, Portugal
Background: Haemodialysis patients frequently develop anaemia which is not only associated with the kidney disease, but also to the haemoglobin (Hb) loss during treatment.
Objectives: To assess whether Hb values are influenced by:
• Restitution volumes (RestVol) (for blood restitution of blood at the end of dialysis sessions) [independent of erythropoietin substitution agents (ESA) and iron doses]
• Iron administration (doses were 20-50mg for fractionated, 100mg for fixed iron)
To assess whether the restitution volume (RestVol) has an influence on Hb values independent of erythropoietin substitution agents (ESA) and Iron doses.
Methods: In 2013, 4,386 patients on haemodialysis ≥3 months from 34 centres were enrolled in a descriptive, retrospective, correlational study. RestVol, Hb values, ESA, and iron doses were assessed on a monthly basis. For data analysis we used moderate linear regression and Wilcoxon test.
Results: The mean age was 69±14 years, 58.9% were men. Evaluation of 665,712 treatments revealed:
• The average RestVol was 345ml.
• RestVol influenced Hb values independently of ESA and iron doses. This influence was statistically significant (p<0.05), but low (0.063).
• 9 clinics with higher RestVol (≥387ml) showed similar data to the other clinics in terms of average Hb values (11.17g/dl±0.135 vs 11.12±0.189g/dl), ESA, and iron doses.
• Fractionated iron administration resulted in 0.54g/dl higher average Hb per unit of iron as compared to the fixed iron approach. This result was statistically significant (p=0.058, p <0.10).
Conclusion/Application to practice: Restitution volumes and iron administration methods influenced the Hb values of the patients.
Disclosure: No conflict of interest declared
O 59
Reduction of water consumption without effects on dialysis quality
B. Demirel1, B. Gunes1, B. Aydemir1, E. Unal1, F. Kircelli1
1Avcilar 2 NephroCare Clinic, İstanbul, Turkey
Background: Haemodialysis (HD) is a highly water-consuming treatment involving 120 l/treatment (trt) used as dialysate at a dialysate flow rate of 500 ml/min. More water is required for dialysate processing. In this study we evaluated whether an adjustment of the dialysate flow (Qd) to the blood flow rate (Qb) with a ratio ≤1.2 may reduce the overall water consumption without affecting dialysis quality.
Methods: 76 out of 142 chronic HD patients treated at the Avcilar 2 Clinic in Istanbul were included in this prospective study. Patients with a history of come-and-go were excluded. The decision to reduce the Qd/Qb ratio was based on Kt/V levels, i.e. Kt/V of 1.6 was required to reduce the ratio Qd/Qb to 1.0. Kt/V was monitored online and all patients had a target blood flow rate of 400 ml/min.
Results: At 6 months, 82% of the patients switched to a Qd/Qb ratio of 1.0. Dialysate consumption decreased from 105.82±11.05 l/trt to 91.83±8.83 l/trt (13.3%). This new awareness among the staff in the centre the total water consumption decreased from 405 to 328 m3 (19%) per treatment. The number of patients reaching a Kt/V >1.4 was comparable at baseline and at the end of the study, phosphate control improved (36 and 26%, respectively), and mean blood flow rate increased from 375 to 395 ml/min.
Conclusion/Application to practice: The use of a Qd/Qb ratio enables a significant reduction of water consumption without affecting dialysis adequacy. This easy-to-handle approach is important not only for dialysis efficiency but also for the environment.
Disclosure:
All authors work for Fresenius Medical Care Turkey.
O 60
Diagnostic therapeutic healthcare pathway for the management of hematologic patients admitted to nephrology department
V. Guadagno1, R. Longo1
1Nephrology, Dialysis and Ipertension, Hemodialysis Unit, Bologna, Italy
Background: The Diagnostic Therapeutic Healthcare Pathway (DTHP) is based on a multidisciplinary plan, designed for specific patients in order to identify all activities that must be performed for obtaining the best accuracy and efficacy of treatment.
Objectives: We present our DTHP of hematologic patients admitted to the Nephrology Department.
Multiple Mieloma (MM) is still one of the most common hematological diseases and it is frequently worsened by acute kidney injury.
Methods: Once diagnosed, the therapeutic approach in collaboration with the hematologists is established and is usually based on a combined therapy. Nephrological therapy consists of extracorporeal treatments, which can have two different aims; to correct metabolic alterations or special extracorporeal treatments designed to remove free light chains.
Results: Recently we treated 7 patients with high adsorptive membranes (double PMMA filter BK-F 2.1, EAD).
Six out of seven patients had renal failure secondary to MM and cast nephropathy. Although the removal was different for kappa and lambda chains, we obtained satisfactory results.
Conclusion/Application to practice: In hemodialysis, the patient is taken care of by a team of professionals and is assigned to a nurse case manager (NCM). Being in charge of a patient means to continuously follow the person and his family, try to understand their needs and offer them the best possible answers. Some needs remain unexpressed and, if undetected, can adversely affect the process of care.
Disclosure: No conflict of interest declared
O 61
Extended darbepoetin alfa dosing apparently reduced erythropoiesis stimulating agent requirement to achieve haemoglobin target
J. Santos1, L. Amado1, V. Povera2, A. Santos-Silva3, 4, E. Costa3,4, V. Miranda1, J. Fazendeiro Matos5
1NephroCare Maia, Fresenius Medical Care, Maia, Portugal; 2UNIFAI, Unit of Research and Training in Adults and Elderly, University of Porto, Porto, Portugal; 3Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal; 4UCIBIO@REQUIMTE, University of Porto, Porto, Portugal; 5NephroCare Portugal, Fresenius Medical Care, Porto, Portugal
Background: The efficacy of extended darbepoetin alfa dosing beyond once-weekly in end-stage renal disease (ESRD) patients has not been sufficiently explored.
Objectives: To evaluate efficacy of extended dosing in ESRD patients to maintain haemoglobin levels.
Methods: We evaluated two groups of ESRD patients: Group I with 16 patients receiving darbepoetin once a week over 12 months and group II with 16 patients receiving darbepoetin once a week during the first 6 months and extended darbepoetin doses (multiple doses: 10 or 20 doses over 6 months) over the remaining 6 months. We evaluated darbepoetin doses, total intravenous iron administration, haematological and inflammatory data, and iron metabolism.
Results: During the first 6 months, patients in group I required 0.5±0.3 µg/kg/week darbepoetin with a total consumption of 11,520 µg for all patients; patients in group II required 0.5±0.4 µg/kg/week with a total consumption of 13,000 µg for all patients. In the following 6 months, a small increase in the darbepoetin doses (0.6±0.2 µg/kg/week) and in total darbepoetin for all patients (12782 µg) was observed in group I. A significant decrease in the darbepoetin dose was observed in group II (0.35±0.2 µg/kg/week) as well as in total darbepoetin consumption (8,880 µg). No significant differences were observed between the two groups in haematocrit and haemoglobin concentration, iron status, inflammatory markers and iron administration doses.
Conclusion/Application to practice: Results showed that both dosing regimens are equivalent in terms of maintaining target haemoglobin concentration, and that an extended darbepoetin alfa dosing seems to reduce the required darbepoetin doses (when calculated and compared per week).
Disclosure: No conflict of interest declared