#5660 ULTRAFILTRATION RATES IN INCIDENT PATIENTS ON INCREMENTAL HAEMODIALYSIS WITH 1 SESSION PER WEEK: ARE THESE RATES DANGEROUS?

Abstract Background and Aims Most patients start haemodialysis (HD) with a fixed dose of three sessions per week, regardless their residual renal function (RKF). This schedule is considered “standard HD or conventional HD” widely accepted without any randomised controlled trial (RCT) having examined whether other schedules fewer week are inadequate harmful. Incremental (iHD), by contrast, adjusts the number to RKF, increasing frequency compensate for drop in RKF. While iHD approaches precision medicine customising sessions, it raises concerns about risk under-dialysis long intersession periods. In absence these periods associated high weight gain (WGI), which leads ultrafiltration rates (UF rates). UF greater than 10 ml/kg/h known be poor prognosis [1]. Pending ongoing RCT [2], our aim quantify WGI incident on single weekly session (1HD/Wk). Method The policy Centre those RKF clinically stable. We 1HD/Wk if urea clearance (KrU) > 4 ml/min/1.73 m2. moved from 1 2, 2 3 sessions/week, depending KrU rates. analysed 2777 66 patients, period ≥ 6 days. Mean age was 73±12.5 years 73% were male. WGI, rate Blood Pressure (BP) pre- post-HD each session. calculated monthly dialysis using Soluter Solver (www.ureakinetic.org). an adequate stdKt/v 2.1 EKRU+KrU 12 [3]. guided fluid management bioimpedance spectroscopy (BIS) bimonthly. Results 1.47±1.3 kg (median 1.4), equivalent 2±1.5% patient weight. According BIS, pre-HD overhydration status 1.9±1.6 1.6L), similar WGI. rate, session, 5.03±3.84 5). 9.1% exceeded ml/min/h 2.6% 13 ml/kg/h. Pre-dialysis BP 158±23/78±19 mmHg 157/76) post-dialysis 152±27/76±16 150/75). measured urinary volume 1931±491 ml 1900) 5,1±1.8 ml/mn/1.73m2 4,8). Dialysis adequate, stdK/v 2,31±0.7 volumes 2,23) EKR+KrU 14,22±3,7 ml/min 13,8). Nutritional as PCRn 1,04±0.3 g/kg/day 1), LTI index at BIS 12,1±4,8 kg/m2 12), desirable >10,5, FTI 15±8 14), >7. Conclusion Patients do not present large gains, nor they subjected rates, avoiding significant changes during sessions. On contrary, allows them maintain low presenting overload, underdialysis malnutrition.