Low-Volume Home Haemodialysis and In-Centre Haemodialysis: Comparison of Dialysis Adequacy in Obese Individuals

Low-Volume Home Haemodialysis and In-Centre Haemodialysis: Comparison of Dialysis Adequacy in Obese Individuals

Background Although frequent low-flow, low-volume haemodialysis using the NxStage System One is now well-established as an option for home therapy of end-stage chronic kidney disease, its ability to deliver adequate dialysis in people with high BMI remains questionable. This doubt may lead to obese...

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Published in:Curēus (Palo Alto, CA) Vol. 15; no. 2; p. e35054
Main Authors: Alalwan, Adel A, Abou Trabeh, Aissar, Ahamed, Mohamed Mujahith Sb, Jones, Samuel, Adjorlolo, Donald, Lewis, Robert, Sangala, Nicholas
Format: Journal Article
Language:English
Published: United States Cureus Inc 16-02-2023
Cureus
Subjects:
Body mass index
Comorbidity
Diabetes
Dialysate
Dialyzers
Hemodialysis
Hypertension
Kidney diseases
Kidney transplants
Morbidity
Nephrology
Obesity
Patients
Peritoneal dialysis
Transient ischemic attack
United Kingdom > UK
comorbid obesity
nxstage system one
in-centre haemodialysis
home haemodialysis (hhd)
haemodialysis (hd)
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Summary:Background Although frequent low-flow, low-volume haemodialysis using the NxStage System One is now well-established as an option for home therapy of end-stage chronic kidney disease, its ability to deliver adequate dialysis in people with high BMI remains questionable. This doubt may lead to obese individuals being denied the potential benefits of this modality. To establish if this doubt is justified, we compared dialysis adequacy in two groups of obese individuals; one receiving standard thrice-weekly in-centre haemodialysis and the other receiving frequent haemodialysis at home using the NxStage System One. Methods This is a retrospective observational cohort study of 105 adult dialysis patients with obesity (BMI ≥ 30 kg/m2). All had been on dialysis for at least six months. Fifty-five patients receiving in-centre haemodialysis were compared with 50 patients receiving home haemodialysis using NxStage System One. Dialysis adequacy (standard Kt/V calculated by the Daugirdas equation) was compared between the two groups. The clinical characteristics, laboratory test results, and treatment regimens of each group were also compared. Results The in-centre haemodialysis group was older (63.6 ± 12.8 years vs. 58.5 ± 10.9 years, p=0.033) and had a higher Charlson comorbidity score (5.9 ± 2.1 vs. 4.5 ± 2.5, p=0.003). Standard Kt/V was significantly higher in the home haemodialysis group (2.4 ± 0.5) than in the in-centre haemodialysis group (2.2 ± 0.2) (p = 0.006). The mean serum inorganic phosphate was significantly lower in the home haemodialysis group than in the in-centre haemodialysis group (1.6 ± 0.4 mmol/l vs. 1.8 ± 0.5 mmol/l, p = 0.010). There were no statistically significant differences in the usage of antihypertensives, phosphate binders, or erythropoiesis-stimulating agents between the two groups. Conclusions In this study, dialysis adequacy (expressed as standard Kt/V) was superior to that of standard thrice-weekly in-center haemodialysis delivered by frequent low-volume home haemodialysis using the NxStage System One. Hesitancy about recommending frequent low-volume home haemodialysis to obese individuals is therefore unjustified.
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ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.35054