P1596CHANGES IN INFLAMMATORY MARKERS AND NUTRITIONAL PARAMETERS IN PATIENTS RECEIVING INCREMENTAL HEMODIALYSIS:A REAL LIFE STUDY
Authors: Drovandi Stefania , Conti Novella , Falqui Valeria , Russo Rodolfo , Massarino Fabio , Moriero Enzo , D'Ercole Martina , Civati Alessandra , Lecini Eldi , Garibotto Giacomo , Cipriani Leda 
Published: June 2020

Abstract

Background and Aims
In the last years a “personalized” hemodialysis (HD), the so-called incremental HD, has been proposed as alternative approach to the standard three-times-weekly HD. By this modality, the dose of dialysis is low at the beginning of RRT and progressively increases over time in parallel with the decrease of residual renal function. Recent studies suggested that an incremental approach to HD initiation and less frequent dialysis regimens may have several benefits, including preservation of renal function and better quality of life. However, little information is available on the effects of incremental hemodialysis on inflammation and nutritional parameters.

Method
We conducted a retrospective analysis of 92 incident adult patients (mean age 72.4±14 years) who started twice-weekly HD between January 2016 to December 2019 at our Unit. 29 patients, who were still on twice-weekly treatment at December 2019, entered the final analysis (mean follow-up 17.5±12 months). Results for C-reactive protein and ferritin, as an expression of inflammation, together with albumin, total cholesterol levels, and normalized protein catabolic rate (nPCR), that reflects nutritional status and daily dietary protein intake, were analyzed over 12 months for all patients. Results are expressed as mean ± standard deviation (SD). Patients mean age was 74±11 years; baseline eGFR 4 ± 1.99 ml/min/1.73mq; Kt/V 1.32±0.38. Males: 62% ; ethnicity: 97% White and 3% Asian. The causes of ESRD were diabetic nephropathy (24%) glomerulonephritis (24% ), hypertensive nephrosclerosis (14%), obstructive nephropathy (17%), interstitial nephritis (7%), acute tubular necrosis (3%) and unknown (11%). Incident patients with a follow-up period shorter than three months were excluded from analysis. Exclusion criteria were: history of neoplasia, inflammatory bowel disease, vasculitis, major acute CV events or infections 12 months before or after the beginning of HD, patient’s refusal to undergo thrice-weekly HD. Baseline characteristics at the time of initiation of twice-weekly HD were compared with characteristics at 3, 6 and 12 months. The variables were analysed using linear regression models. P&lt;.05 values were considered to be statistically significant.

Results
Both C-reactive protein and ferritin showed a nonlinear fitting, with a decline after the first three months (54% and 46% respectively) and a further increase at 6 months (baseline vs 12 months p=0.3 and 0.08, respectively). nPCR, as a trend only, increased progressively with time. Serum albumin increased logarithmically (baseline vs 12 months p=0.04) (Figure 1) with a steep increase at 3-6 months and a moderate increase thereafter. Serum cholesterol increased also progressively over time (baseline vs 12 months p=0.03)(Figure 2).

Conclusion
This study shows that twice-weekly hemodialysis is associated with progressive increase in serum albumin and cholesterol, and, as a trend only, in nutritional intake. However, twice weekly hemodialysis does not seem to be able to control inflammation.