P1058COMPARISON OF THE REMOVAL EFFICIENCY AND THE BIOCOPATIBILITY BETWEEN PRE- AND POST-DILUTION ON-LINE HEMODIAFILTRATION
Authors: Sakurai Kenji , Saito Takeshi , Hosoya Hiromi , Kurihara Yoshitaka , Yamauchi Fumi , Iwadate Yoshiko , Yoshinaga Minami , Yoshida Kazunari , Kenichi Kokubo , Ishii Daisuke , Hyodo Toru 
Published: June 2020

Abstract

Background and Aims
On-line HDF (OL-HDF) performed in Japan is characterized by the fact that pre-dilution OL-HDF (pre-HDF) accounts for 95% of the cases. In Europe, post-dilution OL-HDF (post-HDF) is the mainstream mode, and particularly high-volume post-HDF is reportedly associated with a favorable prognosis in patients. Last year, we reported favorable biocompatibility and removal efficiency of low-volume post-HDF using high-performance hemodiafilters. Here, we performed pre-HDF and post-HDF for 4 weeks each under the same conditions in the previous study and compared the removal efficiency and the biocompatibility.

Method
Nine stable dialysis patients who had received pre-HDF for at least 6 months (age, 60.8±15.4 years; dry weight, 54.5±9.5 kg) were included in this study. Fineflux-210 Seco (asymmetric triacetate membrane, NIPRO) was used as a hemodiafilter. Post-HDF (replacement fluid rate, 12 L/session) was performed in the first session and pre-HDF (replacement fluid rate, 60 L/session) in the second, each lasting 4 weeks. Each study parameter was evaluated on the last day of each session. In either session, HDF was performed at a blood flow rate of 250 mL/min and a total dialysate flow rate of 500 mL/min. Each HDF cycle lasted 4 h. The removal efficiency was evaluated in terms of Kt/V, as well as the removal rates and removal volumes of urea, creatinine, β2-microglobulin (MG), and α1-MG. Biocompatibility was evaluated in terms of the rates of changes in the levels of CRP, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), pentraxin-3 (PTX3), and intercellular adhesion molecule-1 (ICAM-1) before and after dialysis. Changes in the levels of CD62P during dialysis were also examined. Paired t-test was used for statistical analysis.

Results
Removal efficiency results: The removal efficiency for small molecular weight solutes was significantly higher in post-HDF. The removal rate (%) and removal volume (g/session) of β2-MG were 81.4±3.6 and 0.224±0.051 in post-HDF and 80.7±3.3 and 0.218±0.029 in pre-HDF, respectively. The removal rate (%) and removal volume (g/session) of α1-MG were 37.0±4.0 and 0.151±0.024 in post-HDF and 33.3±4.1 and 0.133±0.026 in pre-HDF, respectively. The amount of albumin leakage (g/session) was 3.7±0.6 in post-HDF and 3.1±0.7 in pre-HDF, indicating a significant difference. Biocompatibility results: There were no significant differences between the two modes in the rates of changes in the levels of CRP, PTX3, IL-6, TNF-α, or ICAM-1 before and after treatment. The rate of expression of CD62P was also not significantly different.

Conclusion
Under the present conditions using high-performance filters, post-HDF and pre-HDF demonstrated favorable removal efficiency for both small and large molecular weight solutes, and the biocompatibility was also favorable, indicating no significant differences between the two modes.