Impact of Regular or Extended Hemodialysis and Hemodialfiltration on Plasma Oxalate Concentrations in Patients With End-Stage Renal Disease

• Published in: Kidney international reports Vol. 2; no. 6; pp. 1050 - 1058
• Main Authors: Ermer, Theresa, Kopp, Christoph, Asplin, John R, Granja, Ignacio, Perazella, Mark A, Reichel, Martin, Nolin, Thomas D, Eckardt, Kai-Uwe, Aronson, Peter S, Finkelstein, Fredric O, Knauf, Felix
• Format: Journal Article
• Language: English
• Published: United States Elsevier 01.11.2017
• Subjects: clearance kinetics; Clinical Research; end-stage renal disease (ESRD); hemodialfiltration (HDF); hemodialysis (HD); oxalate; oxalate; end-stage renal disease (ESRD); hemodialfiltration (HDF); hemodialysis (HD); clearance kinetics
• ISSN: 2468-0249; 2468-0249
• DOI: 10.1016/j.ekir.2017.06.002

Calcium oxalate supersaturation is regularly exceeded in the plasma of patients with end-stage renal disease (ESRD). Previous reports have indicated that hemodialfiltration (HDF) lowers elevated plasma oxalate (P ) concentrations more effectively compared with hemodialysis (HD). We reevaluate the therapeutic strategy for optimized P reduction with advanced dialysis equipment and provide data on the effect of extended treatment time on dialytic oxalate kinetics. Fourteen patients with ESRD who underwent HDF 3 times a week for 4 to 4.5 hours (regular HDF; n = 8) or 7 to 7.5 hours (extended HDF; n = 6) were changed to HD for 2 weeks and then back to HDF for another 2 weeks. P was measured at baseline, pre-, mid-, and postdialysis, and 2 hours after completion of the treatment session. Baseline P for all patients averaged 28.0 ± 7.0 μmol/l. Intradialytic P reduction was approximately 90% and was not significantly different between groups or treatment modes [F(1) = 0.63;  = 0.44]. Mean postdialysis P concentrations were 3.3 ± 1.8 μmol/l. A rebound of 2.1 ± 1.9 μmol/l was observed within 2 hours after dialysis. After receiving 2 weeks of the respective treatment, predialysis P concentrations on HD did not differ significantly from those on HDF [F(1) = 0.21;  = 0.66]. Extended treatment time did not provide any added benefit [F(1) = 0.76;  = 0.40]. In contrast to earlier observations, our data did not support a benefit of HDF over HD for P reduction. With new technologies evolving, our results emphasized the need to carefully reevaluate and update traditional therapeutic regimens for optimized uremic toxin removal, including those used for oxalate.