MO641: Hemodiafiltration with Intermittent Infusion Reduces the Incidence of Dialysis Disequilibrium Syndrome in Hemodialysis Patients in the Initiation Phase
Authors: Saito Makoto , Jingu Hiroomi , Osawa Hidefumi , Oyama Yusuke , Tanaka Toshiyuki , Shiono Akihiko , Machida Masami 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The dialysis disequilibrium syndrome (DDS) is a major complication in hemodialysis patients in the initiation phase. Since urea removal restriction is an effective method to prevent DDS, a reduced dialysis dose is used in the initiation phase in hemodialysis patients. However, despite this, some patients still develop DDS in the initiation phase. Hemodiafiltration with intermittent infusion (I-HDF) provides intermittent infusion during dialysis, which can reduce the imbalance between the intravascular and interstitial concentrations, thus maintaining a high plasma osmolarity and potentially high plasma osmolarity, lowering the incidence of DDS. The aim of the present study was to clarify whether starting the treatment with I-HDF is useful for preventing DDS in hemodialysis patients in the initiation phase.

METHOD
Since January 2021, we have used I-HDF at the start of the treatment in patients being initiated on hemodialysis at our hospital. We conducted a retrospective review to examine if there were any changes in the incidence of clinical symptoms such as DDS or the mean blood pressure during dialysis with this mode change. The participants in this study included 11 patients who were started on treatment with conventional low-dose hemodialysis (HD group) (10 males/1 female; 5 diabetic, 6 non-diabetic; mean age, 73.7 years; SD 8.3) and 14 patients who were started on treatment with I-HDF (I-HDF group) (12 males/2 females; 12 diabetic, 2 non-diabetic; mean age, 66.8 years; SD 16.1). We compared the prevalence of symptoms of DDS (headache, nausea, vomiting, leg cramps, fatigue and hypotension), the normalized dialysis dose (spKt/V), the urea nitrogen (UN), serum albumin (Alb), fluid removal rate and mean blood pressure in the HD and I-HDF groups at first treatment. The treatment conditions were FA-150F membrane for the HD group and FIX-170E membrane for the I-HDF group, with a blood flow rate of 150 mL/min, dialysate flow rate of 500 mL/min and treatment time of 3-h in both groups. I-HDF was carried out with five infusions of 150–200 mL/min for one minute by back filtration of the dialysate every 30 minutes.

RESULTS
A significantly lower incidence of DDS was noted in the I-HDF group, with 3 events in the I-HDF group as compared with 17 events in the HD group (P &lt; .01, chi-squared test). There was no significant difference in the spKt/V, UN, Alb, or fluid removal rate between the two groups (P = .80, P = .28, P = .96 and P = .20, respectively). The mean blood pressure was significantly lower in the HD group than in the I-HDF group (P &lt; .05, t-test). These results indicated that the incidence of DDS could be reduced by starting treatment with I-HDF in patients being initiated on hemodialysis, because the intentional loading of fluid by intermittent infusion may enhance plasma refilling and have a positive effect on suppressing any rapid changes in the plasma osmolality.

CONCLUSION
I-HDF was useful for maintaining the blood pressure and reducing the incidence of dialysis disequilibrium syndrome in the initiation phase in hemodialysis patients.