Nutrition in Chronic Kidney Disease: Nephrology Dialysis Transplantation Notable Advances in 2018

Philippe Chauveau

Disclosures

Nephrol Dial Transplant. 2019;34(6):893-896. 

In This Article

Haemodiafiltration and Muscle Mass

Online haemodiafiltration (OL-HDF) could be considered as the best treatment for HD patients since it combines convective and diffusive clearance. Benefits of OL-HDF have been discussed in cohort studies, mainly due to differences in reinjection volume. Few randomized studies have been published. Higher removal of uraemic toxins could be an advantage for nutritional status. In the previously published large studies CONTRAST (Convective Transport Study) or ESHOL (OL-HDF Survival Study), no advantage for nutritional status was observed, but only weight change or biochemical variables were assessed. The ProtEin Stores prEservaTion (PESET) study, published by Molina et al.,[13] was a 12-month controlled prospective study that compared OL-HDF with high-flux standard HD treatment (HF-HD). Thirty-three HD patients were randomized. The same dialyser was used. Kt/V should be >1.2. Mean dialysis length was 4.2 h, three times a week. Body composition using bioimpedance spectroscopy (Fresenius Medical Care, Bad Homburg, Germany) was evaluated at study start and every 4 months, before a mid-week session. Muscle function using handgrip strength (HGS) was also assessed, combined with protein intake appearance calculation, albumin and prealbumin levels, and self-reported appetite. Mean reinjection volume was close to 21 L/session. Lean tissue and body cell mass did not vary in the OL-HDF group but decreased in patients maintained on HF-HD at 12 months. Protein intake increased in the OL-HDF group, whereas albumin levels, HGS and weight did not change in either group. There was a decreasing trend in high-sensitivity C-reactive protein levels in the OL-HDF group. This is the first randomized study supporting the hypothesis that HDF with high convective volume is able to positively affect nutritional status. Loss of albumin or other nutrients have been previously questioned. In this study, calories and protein intake using food records were not assessed and should be included in a future study to confirm the impact of reduction of uraemic toxins on food intake.

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