the effect of nocturnal haemodialysis on body composition karin ipema, dietician/researcher,

The effect of Nocturnal Haemodialysis on Body Composition

Karin Ipema, dietician/researcher, Dialysis Center Groningen

In cooperation with Hanze University Groningen, Professorship in Health Care and Nursing

1 September 2013

Background

• 20 -70% Malnutrition and poor physical functioning in dialysis patients

• Decline in muscle and fat tissue

• Nocturnal HD: • Increase in protein intake• More free time• Improving Quality of life

Study Question

Is the transition from conventional HD to nocturnal HD after 1 year associated with an increase in fat and/or fat-free mass?

Patients

• Research group: Nocturnal haemodialysis patients (±4-6 x pw 8 hours dialysis)

• Nocturnal In-centre Haemodialysis – every other night 8 hrs dialysis• Nocturnal Home Haemodialysis– 5-6 night pw 8 hrs dialysis

• Control group: Conventional Haemodialysis, matched on gender, age, and dialysis vintage (±3 x pw 4 hrs dialysis)

• Inclusion criteria: chronic haemodialysis patients, aged >18 years who were scheduled to start on NHD

• Exclusion criteria: short life expectancy (<1 year), a substantial amount of metal in the body, absence of informed consent

Inclusion and exclusion criteria

Method

• DEXA-scan Whole body composition

• DEXA-scan shortly after the dialysis session

CHD Nocturnal HD

Conventional HD

Dexa 1 Dexa 2

CHD

DEXA scan

Method

Study design:• DEXA-scan Whole body

composition• DEXA-scan shortly after the

dialysis session• Laboratoy measurements:

albumin, nPCR, e.g.• Statistical analysis with

Linear mixed models

Results

Patient characteristics:• Recruitment period of 3 years• 21 patients included in the research group, 10 patients did not

complete the first year of NHD, :• N=2: difficulty with sleeping• N=7: severe intercurrent sickness (sepsis, hart failure with low blood

pressures)• N=1: kidney transplantation

Results

Nocturnal haemodialysis

• N=11 - 6 NHHD / 5 NCHD• 6 male / 5 female• Years on dialysis: 4.7 (1-15)• DM: 1 person• BMI 24.7 kg/m2 (±3.7)

Conventional haemodialysis

• N=13• 8 male / 5 female• Years on dialysis: 3.7 (1-11)• DM: 2 persons• BMI 25.8 kg/m2 (±3.9)

No significant differenceEffect size interaction: +0.23 g/kg/day(P= 0.027)

Results Protein intake & Albumin

No significant difference No significant difference No significant difference

Results Body Composition

Results Covariates

Co-variates:• Gender• Age• Dialysis vintage

Dialyse vintage shows a negative effect on the fat mass, total mass, and BMI:• Fat mass: -1.48 kg per year (P=0,010)• Total mass: -1.65 kg per year (P=0,018)• BMI: -0.6 kg/m2 per year (P=0,011)

Conclusion

In this study we observed a significant increase in protein intake after the transition from CHD to NHD.

One year of nocturnal haemodialysis had no significant effect on body composition in comparison with CHD patients, despite a higher protein intake.

In this relatively small study, a longer dialysis vintage had a negative effect on fat mass and BMI. Dialysis vintage seems to have more effect on the body composition than the form of haemodialysis.

Questions

Karin J.R. Ipema1,2, Ralf Westerhuis1,3, Cees P. van der Schans2,4, Paul E. de Jong3, Wim P. Krijnen2, Riemer H.J.A. Slart5, and Casper F.M. Franssen3

1Dialysis Center Groningen, 2Professorship in Health Care and Nursing – Hanze University Groningen, University of Applied Sciences, 3Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, 4Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands, 5Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

Tack för att ni lyssnade Vi ses i Groningen