Clinical outcomes associated with intradialytic food ingestion in patients undergoing high volume online haemodiafiltration

Abstract

Introduction: The quality of haemodialysis (HD) treatment received by chronic renal failure patients is important for their overall well-being. Adequate HD improves patients quality of life, minimizes disease complications and hospitalizations. Dialysis inadequacy over a prolonged period exacerbates pre-existing conditions, increases morbidity and mortality, deteriorates patients health leading to a poor quality of life. Mitigating factors that may contribute to dialysis inadequacy is important for optimizing patient care and achieving good clinical outcomes. Dialysis centres often provide meals for patients while receiving their treatment. The aim of the study was to evaluate whether intradialytic food intake may affect dialysis adequacy in patients undergoing online haemodiafiltration (OL-HDF). In the present study Single- pool Kt/V and urea reduction ratio (URR) were the measurements of molecular clearance utilized to measure dialysis adequacy. Methodology: The study was conducted at Fresenius medical care dialysis clinics on adult patients undergoing OL-HDF treatment. Consent was obtained from the patients. Adequacy of dialysis was assessed using SpKt/V and URR. Patients underwent sampling of pre-dialysis and post-dialysis urea for the calculation of URR and SpKt/V was obtained from OCM® feature on the 5008s haemodialysis machine. The sampling was done on two consecutive mid-week treatments with and without food ingestion. The principal investigator also recorded MAP at 30 minute intervals for the assessment of post-prandial hypotension and pre- and post-Hgt for blood glucose stability during sessions with and without food ingestion. Results: Fifty-two adult chronic renal failure patients were enrolled into the study. Twenty-four were males and twenty 28 females. The two groups of participants included the AV-Fistula group which consisted of 38 participants (73.1%) and the Permanent catheter group 14 participants (26.9 %). The total sample was made of African, Indians and Whites. There were 21 Africans, 30 Indians and 1 White. The age distribution for AV-Fistula group was 55.29±8.45years (Mean±SD) and for Permanent catheter group was 56.86±10.35years. The mean URR with food ingestion 70.9±9.93 (p = 0.918) and without food ingestion 70.9±7.41 (p = 0.508). The mean spKt/V with food ingestion was 1.26±0.29 (p = 0.599) and without food ingestion 1.26±0.30 (p = 0.788). During sessions without food ingestion 13.5% of the patients were recorded to have hypotensive episodes and 86.5% did not experience hypotensive episodes. During sessions with food ingestion 38.5% patients were recorded to experience hypotensive episodes and 61.5% did not experience hypotensive episodes. There was a significant difference in the number of patients who did not have a hypotensive episode compared to those who did (p < 0.001). There wereno participants classified with hypoglycaemia as all of the minimum values were greater than 4.0mmol/L. The Mean±SD with food ingestion pre-dialysis was 9.12±4.93, post-dialysis 8.39±2.56. The Mean±SD without food ingestion predialysis was 9.39±4.38 and post-dialysis was 7.22±2.26. Discussion: The spKt/V and URR values for both the AV-Fistula and Permanent catheter groups were in optimal range as recommended by the KDOQI guidelines. There was no significant difference in the spKt/V and URR values achieved from the OL-HDF sessions with and without intradialytic food ingestion. Intradialytic food ingestion did not negatively impact dialysis adequacy, although it was noted that during sessions of food ingestion more patients did experience post-prandial hypotension as compared to without food ingestion and post-dialysis blood glucose levels were lower during sessions without food ingestion as compared to with food ingestion, there was no significant difference in these variables. Conclusion: Intradialytic food ingestion is recommended for patients undergoing OLHDF treatment. Patients that suffer severe malnutrition and low albumin levels should be considered to be treated with OL-HDF treatment and intradialytic feeding should introduced. This may contribute in an increase in quality of life in patients with CKD