Chiara Carla Maria Brunati1, Francesca Gervasi1,2, Mara Cabibbe1, Federica Ravera1, Alberto Menegotto1, Marialuisa Querques1, Giacomo Colussi3. 1. Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 2. Nephrology School, Milano-Bicocca University, Milan, Italy. 3. Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, giacomo.colussi@ospedaleniguarda.it.
Abstract
BACKGROUND: NxStage System One cycler (NSO) is a widespread system for home daily dialysis. Few data are available on the impact of this "low dialysate volumes system" on the removal rate of poorly diffusible, time-dependent solutes like β2-microglobulin (β2M). METHODS: Single-session and weekly balances of β2M were performed and compared in 12 patients on daily NSO, 13 patients on standard high-flux bicarbonate dialysis (BHD), 5 patients on standard post-dilution on line hemodiafiltration (HDF), and 13 patients on automated peritoneal dialysis (APD). RESULTS: Intradialytic fall of plasma water β2M levels (corrected for rebound) was 65.2 ± 2.6% in HDF, 49.8 ± 9.1% in BHD, and 32.3 ± 6.4% in NSO (p < 0.001 between all groups). Single treatment dialysate removal was much less in APD (19.4 ± 20.4 mg, p < 0.001) than in any extracorporeal technologies, and was less in NSO (126.2 ± 35.6 mg, p < 0.001) than in BHD (204.9 ± 53.4 mg) and HDF (181.9 ± 37.6 mg), with no differences between the latter 2; however weekly removal was higher in NSO (757.3 ± 213.7 mg, p < 0.04) than in BHD (614.8 ± 160.3 mg) and HDF (545.8 ± 112.8 mg). Extrapolated β2M adsorption to the membrane was negligible in BHD, 14.7 ± 9.5% of total removal in HDF and 18.3 ± 18.5% in NSO. Integration of single session data into a weekly efficiency indicator (K × t) showed total volume of plasma cleared in NSO (33.4 ± 7.7 L/week) to be higher than in BHD (26.9 ± 7.2 L/week, p < 0.01) and not different than in HDF (36.2 ± 4.7 L/week); it was negligible (3.2 ± 1.0) in APD. CONCLUSIONS: Weekly β2M removal efficiency proved equal and highest in HDF and NSO (at a 6/week prescription), slightly lesser in BHD and lowest in APD.
BACKGROUND: NxStage System One cycler (NSO) is a widespread system for home daily dialysis. Few data are available on the impact of this "low dialysate volumes system" on the removal rate of poorly diffusible, time-dependent solutes like β2-microglobulin (β2M). METHODS: Single-session and weekly balances of β2M were performed and compared in 12 patients on daily NSO, 13 patients on standard high-flux bicarbonate dialysis (BHD), 5 patients on standard post-dilution on line hemodiafiltration (HDF), and 13 patients on automated peritoneal dialysis (APD). RESULTS: Intradialytic fall of plasma water β2M levels (corrected for rebound) was 65.2 ± 2.6% in HDF, 49.8 ± 9.1% in BHD, and 32.3 ± 6.4% in NSO (p < 0.001 between all groups). Single treatment dialysate removal was much less in APD (19.4 ± 20.4 mg, p < 0.001) than in any extracorporeal technologies, and was less in NSO (126.2 ± 35.6 mg, p < 0.001) than in BHD (204.9 ± 53.4 mg) and HDF (181.9 ± 37.6 mg), with no differences between the latter 2; however weekly removal was higher in NSO (757.3 ± 213.7 mg, p < 0.04) than in BHD (614.8 ± 160.3 mg) and HDF (545.8 ± 112.8 mg). Extrapolated β2M adsorption to the membrane was negligible in BHD, 14.7 ± 9.5% of total removal in HDF and 18.3 ± 18.5% in NSO. Integration of single session data into a weekly efficiency indicator (K × t) showed total volume of plasma cleared in NSO (33.4 ± 7.7 L/week) to be higher than in BHD (26.9 ± 7.2 L/week, p < 0.01) and not different than in HDF (36.2 ± 4.7 L/week); it was negligible (3.2 ± 1.0) in APD. CONCLUSIONS: Weekly β2M removal efficiency proved equal and highest in HDF and NSO (at a 6/week prescription), slightly lesser in BHD and lowest in APD.
Authors: Jordana D Lima; Murilo Guedes; Roberto Pecoits-Filho; Lia S Nakao; Silvia D Rodrigues; Ana Clara S Flórido; Andrea N Moreno-Amaral; Ana Beatriz Barra; Maria Eugênia Canziani; Américo Cuvello-Neto; Carlos Eduardo Poli-de-Figueiredo Journal: J Nephrol Date: 2022-03-03 Impact factor: 4.393