The effectiveness of on-line hemodiafiltration in patients with chronic kidney disease: risk factors and improving the assessment of fluid excretion values

Abstract

Hemodiafiltration on-line (HDF OL) cannot be considered sufficiently studied in terms of its effect on the outcome. THE AIM. To identify the possible relationship of individual anthropometric, laboratory data and parameters of the prescribed treatment regimen with better survival when using the HDF OL. PATIENTS AND METHODS. A retrospective study of the EuCliD database of patients treated with HDF OL in 27 Fresenius Medical Care centers in the Russian Federation during 2014 was conducted. All patients received postdilution HDF OL procedures at least 3 times a week, lasting at least 12 hours a week, with adequacy of Kt/V procedures of at least 1,4. Data from survivors (9616) and deceased (370) patients were compared. The analyzed indicators were: gender, age, treatment experience, body weight, body mass index (BMI), body surface area (BSA), total body water volume (TBW), the volume of distribution (V Urea BCM), presence of diabetes mellitus, coronary heart disease, heart failure, as well as the parameters of the procedure: effective weekly dialysis time, Kt/V, effective in-fusion volume (EIV), effective convection volume (ECV). RESULTS. Risk factors for death in patients with CKD 5D treated with HDF OL include male gender, older age, con-comitant diseases, lower body weight, and BMI, shorter effective weekly dialysis time, lower EIV and ECV values, Kt/V, higher hypercalcemia, hypoalbuminemia, lower hemoglobin levels, higher b2-microglobulin levels, and CRP. Сomparing the normalized BMI, BSA, TBW, V Urea BCM indicators, we identified those that were associated with a high risk of mortality in the population of dialysis patients. CONCLUSION. As a result of this work, two normalized ratios were identified (the median ratio of effective infusion volume to body surface area and the median ratio of effective convection volume to body surface area), which were associated with a high risk of mortality in the population of dialysis patients.