The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study
Por:
Molina P, Vizcaíno B, Molina MD, Beltrán S, González-Moya M, Mora A, Castro-Alonso C, Kanter J, Ávila AI, Górriz JL, Estañ N, Pallardó LM, Fouque D and Carrero JJ
Publicada:
1 jul 2018
Resumen:
Background. Compared with conventional haemodialysis (HD), online haemodiafiltration (OL-HDF) achieves a more efficient removal of uraemic toxins and reduces inflammation, which could favourably affect nutritional status. We evaluate the effect of OL-HDF on body composition and nutritional status in prevalent high-flux HD (HF-HD) patients.
Methods. In all, 33 adults with chronic kidney disease (CKD) Stage 5 undergoing maintenance HF-HD were assigned to post-dilution OL-HDF (n = 17) or to remain on HF-HD (n = 16, control group) for 12 months. The primary outcome was the change in lean tissue mass (LTM), intracellular water (ICW) and body cellmass (BCM) assessed by multifrequency bioimpedance spectroscopy (BIS) at baseline and 4, 8 and 12 months. The rate of change in these parameters was estimated with linearmixed- effectsmodels.
Results. Compared with OL-HDF, patients assigned to HF-HD experienced a gradual reduction in LTM, ICWand BCM. These differences reached statistical significance at Month 12, with a relative difference of 7.31 kg [95% confidence interval (CI) 2.50-12.11; P = 0.003], 2.32 L (95% CI 0.63-4.01; P = 0.008) and 5.20 kg (95% CI 1.74-8.66; P = 0.004) for LTM, ICW and BCM, respectively. The normalized protein appearance increased in the OL-HDF group compared with the HF-HD group [0.26 g/kg/day (95% CI 0.05-0.47); P = 0.002], with a relative reduction in high-sensitive C-reactive protein [-13.31 mg/dL (95% CI -24.63 to -1.98); P = 0.02] atMonth 12.
Conclusions. OL-HDF for 1 year compared with HF-HD preserved muscle mass, increased protein intake and reduced the inflammatory state related to uraemia and dialysis, supporting the hypothesis that high convection volume can benefit nutritional status and prevent protein-energy wasting in HD patients.
Filiaciones:
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
European Renal Nutrition (ERN) Working Group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA)
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
Molina MD:
Department of Mathematics, Universidad de Alicante, Alicante, Spain
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
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Department of Clinical Analysis, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
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Department of Nephrology, Hospital Clínico Universitario, INCLIVA and Department of Medicine, Universitat de València, València, Spain
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Department of Clinical Analysis, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
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Department of Nephrology, Hospital Universitari Dr Peset, REDinREN, FISABIO, Department of Medicine, Universitat de València, València, Spain
Fouque D:
European Renal Nutrition (ERN) Working Group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA)
Department of Nephrology, Université de Lyon, UCBL, Carmen, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
Carrero JJ:
European Renal Nutrition (ERN) Working Group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA)
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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