The effect of high-volume online haemodiafiltration on nutritional status and body composition: The Protein Stores Preservation (PESET) study

A study in the current issue of NDT (Nephrology Dialysis Transplantation) shows: High volume online haemodiafiltration (OL-HDF) has a beneficial effect on body composition and nutritional status.

Post-dilution online haemodiafiltration (OL-HDF) is considered the most efficient renal replacement treatment modality and its use is steadily increasing. Compared with conventional HD, OL-HDF enables better removal of middle molecular weight uraemic toxins by combining convective and diffusive clearance.

Doctor Pablo Molina and his colleagues performed a prospective, controlled, quasi-randomized study to evaluate the effects of high-volume post-dilution OL-HDF on body composition and nutritional status in prevalent HD patients. 33 patients were randomized and assigned to OL-HDF treatment or remained on HF-HD. All patients received dialysis treatment thrice weekly. The primary outcome measures were the change from baseline to the end of the study in lean tissue mass (LTM), intracellular water (ICW) and body cell mass (BCM; the metabolically active component of LTM) measured quarterly throughout the 12-month intervention.

As a result, lean body mass remained stable in the OL-HDF group but decreased in the HF-HD group. These differences were statistically significant at Month 12.

 

 

All in all this study supports the hypothesis that high volume OL-HDF can positively impact on the protein hypercatabolic state of HD patients, it may contribute to preserve lean body mass, stabilize protein and fat stores, increase protein intake and reduce inflammation. This might be an important insight, because we all know that patients on HD are at an elevated risk for morbidity and mortality - and this seems to correlate to poor nutritional status. Of course, our study had a relatively small sample size, therefore larger trials are needed for verification.

Doctor Molina

 

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