Dr Nuha Ibrahim1,2, Dr Mani Panat1,2,3
1East Coast New England Renal Network, 2Tamworth Rural Referral Hospital, 3New England Local Health District
Background: Haemodialysis with Medium Cut-off membranes (MCO-HD) have consistently shown non-inferiority to hemodiafiltration (HDF) in terms of clearance of middle molecule uraemic toxins and inflammatory biomarkers. There may also be a benefit towards improved EPO-index and quality-of-life from some recent studies. In addition, a recent RCT showed equivalent cardiovascular parameters at 1-year compared to HDF.
Aim: The aim was to compare HDF and MCO-HD.
Methods: In a single-centre, prospective crossover observational study, 32 stable HDF patients were switched to MCO-HD with Baxter Theranova-400/500 and important clinical parameters were measured pre-crossover and post-crossover after 3 and 6 months.
Results: There were 32 patients with mean age of 64.3 years and 65% of them were male. 34% patients were indigenous and in 60% of patients vascular access was native AV Fistulas. There were no statistically significant differences between pre and post-crossover mean values of kt/V, serum Albumin, pre-HD bicarbonate, calcium, phosphate, PTH, Alkaline phosphatase, haemoglobin, Ferritin, transferrin saturations, EPO resistance index, Ideal body weight and number of anti-hypertensives used. In addition, integrated palliative care outcome scale (IPOS) scores did not differ before and after being switched to MCO-HD.
Conclusions: Our study showed no difference in clinical parameters before and 6-months after switching from HDF to MCO-HD and this is consistent with recent literature. Previously, pooled data from RCTs pointed towards a mortality benefit of HDF compared to conventional HD especially in patients receiving higher convection volumes. However HDF is more resource-intensive, requires higher blood flow rates and is more costly. Therefore MCO-HD provides a good alternative to HDF and bigger studies with longer follow ups are needed to determine if there are benefits superior to HDF.
Biography:
Nephrology advanced trainee, East Coast New England Renal Network