The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials

<b><i>Introduction:</i></b> The Frequent Hemodialysis Network (FHN) Daily and Nocturnal trials aimed to compare the effects of hemodialysis (HD) given 6 versus 3 times per week. More frequent in-center HD significantly reduced left-ventricular mass (LVM), with more pronounced effects in patients with low urine volumes. In this study, we aimed to explore another potential effect modifier: the predialysis serum sodium (SNa) and related proxies of plasma tonicity. <b><i>Methods:</i></b> Using data from the FHN Daily and Nocturnal Trials, we compared the effects of frequent HD on LVM among patients stratified by SNa, dialysate-to-predialysis serum-sodium gradient (GNa), systolic and diastolic blood pressure, time-integrated sodium-adjusted fluid load (TIFL), and extracellular fluid volume estimated by bioelectrical impedance analysis. <b><i>Results:</i></b> In 197 enrolled subjects in the FHN Daily Trial, the treatment effect of frequent HD on ∆LVM was modified by SNa. When the FHN Daily Trial participants are divided into lower and higher predialysis SNa groups (less and greater than 138 mEq/L), the LVM reduction in the lower group was substantially higher (−28.0 [95% CI −40.5 to −15.4] g) than in the higher predialysis SNa group (−2.0 [95% CI −15.5 to 11.5] g). Accounting for GNa, TIFL also showed more pronounced effects among patients with higher GNa or higher TIFL. Results in the Nocturnal Trial were similar in direction and magnitude but did not reach statistical significance. <b><i>Discussion/Conclusion:</i></b> In the FHN Daily Trial, the favorable effects of frequent HD on left-ventricular hypertrophy were more pronounced among patients with lower predialysis SNa and higher GNa and TIFL. Whether these metrics can be used to identify patients most likely to benefit from frequent HD or other dialytic or nondialytic interventions remains to be determined. Prospective, adequately powered studies studying the effect of GNa reduction on mortality and hospitalization are needed.

P1536EVOLUTION OF A COHORT OF PATIENTS UNDERGOING HOME ONLINE HEMODIAFILTRATION DURING A THREE YEAR FOLLOW UP PERIOD

Background and Aims Online haemodiafiltration (OL- HDF) is the gold standard therapy in hemodialysis, as it has shown to reduce all-cause mortality in hemodialysis patients. Frequent hemodialysis has also shown to improve survival and quality of life. Home hemodialysis facilitates frequent therapy, and it is possible to perform OL-HDF at home, althought there is lack of evidence on its use. We report the evolution of a cohort of patients undergoing home OL-HDF during a 3 year follow up period. Method We designed a prospective, descriptive study to determine the evolution of prevalent and incident patients in home OL-HDF since 2016. Demographic and clinical variables were collected, including those related to hemodialysis technic and its potential complications. Results Three patients with a mean age of 47 years underwent home OL-HDF during follow up. All patients were males and caregiver was the couple in all cases. Two patients had an arteriovenous fistula (AVF) and one had a catheter. After a mean training period of 2.5 months at hospital, they started home OL- HDF with the assitance of a nephrologist, a nurse and a technician in the first session at home. We used the “5008-home”®FMC monitor and the AquaC®FMC for water treatment. Water cultures allways fulfilled the criteria for ultrapurity. Dialysis scheme was 2 hour sessions daily, 6 days a week. During a mean follow up of 15 months, one patient received a kidney transplant. None needed hospitalization. One patient attended the emergency room once for fluid overload and needed ultrafiltration. The patient with catheter needed a catheter replacement due to hole infection. No vascular access problems were recorded in patients with AVF. Regarding dialysis efficacy, mean week KtV was over 2.1 in all cases and mean convective volumen achieved was 94 l/week. Conclusion In our experience, home OL-HDF is a safe and effective technic.