A COMPARISON OF PATIENT STABILITY AND TOLERABILITY ON STANDARD BICARBONATE DIALYSIS AND ACETATE FREE PAIRED HAEMODIAFILTRATON(PHF).

C Rhodes, N Selby, R.J. Fluck.. M. W. Taal, C. W McIntyre

Derby City General Hospital

Problem Standard bicarbonate dialysis still involves 25-50% of transferred buffer into the patient being acetate. Acetate is associated with intradialytic hypotension(IDH).IDH is a common problem that occurs in 20-30% of patients receiving thrice weekly haemodialysis therapy (HD), and is associated with increased mortality.

Purpose To compare the effects of standard bicarbonate dialysis to PHF. PHF is an on line haemodiafiltration technique which is performed using the Belco® formula 2000 monitor with a double chamber dialyser which allows for reinfusion of ultra pure dialysate during treatment, and uses acetate free bicarbonate buffering.

Design 12 patients on chronic HD were recruited for a prospective randomised crossover study between August and November 2004. Patients were randomised to 2 groups, 1 group received thrice weekly HD for a 2 week period, and 1 group commenced on thrice weekly PHF. The groups then crossed over to the other dialysis modality for a further 2 weeks, acting as their own controls. During each phase patients had continuous blood pressure monitoring, any intradialytic symptoms were recorded, blood samples were collected before and after each session, and quality of life was assessed by patient questionnaire.

Findings During standard haemodialysis and PHF the mean blood pressure was the same but the number of IDH episodes was less with PHF. The total number of IDH episodes during standard haemodialysis was 37 (3.1 ± 5.8 per patient per treatment) as compared with 23 episodes during PHF (1.9 ± 3.7 per patient per treatment)Biochemical results were similar between the 2 treatments apart from troponinTlevels, which is a marker of cardiac damage. Pre treatment troponin T levels were lower with PHF at 0.072 ± 0.08(0.01-0.24) μg/l as compared with HD at 0.085 ± 0.08(0.01-0.26) μg /l. post treatment levels rose with HD but fell with PHF. 4 out of 12 patients reported an improvement in overall well-being, with better energy levels, during the PHF treatment period. No patients reported any detrimental effects of PHF.

Conclusion PHF was tolerated by all patients and staff were able to easily perform this treatment. Initial data suggests PHF can reduce the number of IDH episodes which patients experience during treatment

Relevance With an increasing population of patients who may not tolerate standard haemodialysis therapy, PHF could provide an alternative treatment choice.