S 28 Parallel Session

Abstracts:

GUEST SPEAKER
New technology for: CRRT, Plasma Exchange and Blood Exchange in Infants
F. Garzotto¹, M. Zanella¹, A. Brendolan¹, F. Nalesso¹, C. Ronco^1
1Nephrology, St. Bortolo Hospital, Vicenza, Italy

Background CRRT is becoming the treatment of choice to support critical pediatric patients with AKI and fluid overload(FO).This therapy is usually performed with machines designed for adults thus necessarily with an over-dimensioned catheter. This is a case of a newborn with severe FO who received CRRT primarly to remove fluid excess
Methods: Patient 3.165 Kg was a 39 gestational week female,born with dystocic delivery and Apgard score 2-5-5(1-5-10m).Patient was immediately intubated and transferred to the pICU with hemorrhagic shock and MOFS due to subgaleal hemorrhage.A total of 18 transfusions of blood product was done during the first 48h.Oligoanuric despite continuous diuretic infusion and the need of fluid intake to preserve the hemodynamic,result in a 63%FO
Results: CVVH was performed, PRISM2=32, using a double lumen 4FR(2in) catheter placed in the femoral vein.A total of 401 hours of CRRT was done.Mean Blood flow was 11±2ml/m and Net UF 20.2± 5.6ml/h.Infusion was setting to maintain the Filtration Fraction<20%. Hyperbilirubinemia due to hematoma adsorption,suggests the need of SPAD.We also perform,4 plasma exchange PE and 1 exchange transfusion ET done successfully with our development of these new tecniques on the CARPEDIEM machines.
Conclusion/Application to practice:For the first time we were able to use a small and adequate double lumen catheter to perform CRRT in newborn with excellent circuit survival 18.1±3.7.Tab1 shows arterial and venous pressures at different blood flows,during the first phases of the 37 treatments performed

BIOGRAPHY OF THE GUEST SPEAKER
O 45
Manual of standards for management of dialysis water
G. Pacor^1
1Nefrologia e dialisi, AOUTS Ospedali Riuniti di Trieste, Trieste, Italy

Objectives: Many countries have published guidelines regarding purification for water destined to be used for haemodialysis. In Italy guidelines were last published in 2005. More recently an update has been written covering an overview of dialysis water treatment including a literature review and personal practical experience which developed over the course of managing water treatment plants. The title of the work is: “Manuale degli Standard per la gestione degli impianti di trattamento dell’acqua per la dialisi” (Wichtig Editore, 2014). The book includes a theoretical and practical description of all existing types of water purification for dialysis and includes 30 updated recommendations for water management based on standard technical parameters. The text is divided in 6 chapters, contains 27 tables, 5 checklists, 15 figures and 2 glossaries of technical terminology. This text does not substitute the single manufacture’s manual provided with water treatment plants, but can be used as a supplemental guide by dialysis technicians to facilitate the management and improve the quality of water flowing to the patients. The text is especially useful as a reference for developing a plan for monitoring the technical function of the water treatment plant and for controlling the efficacy of maintenance and disinfection protocols, as well as maintaining chemical and microbiologic standards.

Disclosure: No conflict of interest declared

O 46

Neuromuscular electrostimulation in haemodialysis patients: a novel method to improve physical condition
A. Junqué¹, G. Iza¹, E. Tomás¹, O. Paz¹, I. Luceño¹, V. Esteve¹, M. Lavado¹, M. Ramírez de Arellano^1
1Nephrology, Hospital de Terrassa.Consorci Sanitari Terrassa, Terrassa, Spain

Background: Haemodialysis (HD) patients experience muscle wastage and decreased physical function.Few studies about neuromuscular electrostimulation (EMS) in HD patients have been published.
Objectives: To analize the effect of an intradialysis quadriceps EMS training program in muscular strength, functional capacity and quality of life in our HD patients.
Methods
A 12 weeks single-center prospective study.HD patients were assigned into EMS program (EMS) or control group (C).EMS program was performed using the Compex® Theta 500i device in both quadriceps in HD session.C group received standard care.Analized data:1.-Muscular data:Maximum Length Quadriceps Strength(MLQS) and Hand-grip dominant arm(HG).2.-Functional capacity tests:“Sit to stand to sit"(STS10) and “six-minutes walking test”(6MWT).3.-Health questionnaire:EuroQol-5D(EQ-5D).4.-Satisfaction degree:Visual analogic scale (VAS), subjective rating scale (SRS) and EMS questionnaire (SEQ) were completed.
Results: 38 patients participated in the study. 54% were men.23 were on EMS,15 on C group.In contrast with C group, EMS group significatly (*p<0,05) improved in MLQS*(10.2±6.7 vs 13.1±8.1 kg), STS10* (41±18.7 vs 32.8±14.1 sec) , 6MWT* (12%, 280.5vs312.4m)and EQ-5D score *(52.5 vs 65.7%) at the end of the study.However, lower leg SEQ score*(8.5vs5.8 sympt/pac) in EMS group was observed, mainly due to relevant muscular pain, cramps, pins and needles and numbness.In EMS group, 44% and 72% acknowledged better  sensation and physical condition in the SRS, respectly. EMS group VAS score was 7.8 points.
Conclusion/Application to practice:
1.-Intradialytic neuromuscular electrostimulation of both quadriceps improved muscular strength, functional capacity and quality of life in our HD patients.2.-Neuromuscular electrostimulation was safe and well tolerated.3.-However, neuromuscular electrostimulation could be an effective alternative helping to improve the physical condition and quality of life of these patients.
Disclosure: No conflict of interest declared

O 47
Evaluation of the effects of nocturnal home haemodialysis on dialysis adequacy
S. Cicek¹, L. Haydanli¹, I. Hasturk², Y. Ozdemir³, M. Yilmaz⁴, F. Tokyay⁵, F. Ozkan⁶, S. Erten¹, C. Demirci^7
1Sevgi Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ²Avcilar 2 Dialysis Center, Fresenius Medical Care, Istanbul, Turkey; ³Korfez Dialysis Center, Fresenius Medical Care, Iskenderun, Turkey; ⁴Yasam Dialysis Center, Fresenius Medical Care, Ankara, Turkey; ⁵Mersin Dialysis Center, Fresenius Medical Care, Mersin, Turkey; ⁶Kecioren Dialysis Center, Fresenius Medical Care, Ankara, Turkey; ⁷Ege Nefroloji Dialysis Center, Fresenius Medical Care, Izmir, Turkey

Background: Nocturnal home haemodialysis (NHHD) provides increased flexibility to patients and the possibility of prolonged treatment time, which may result in improved dialysis adequacy, quality of life and reduced morbidity and mortality.
Objectives: To compare dialysis adequacy parameters of NHHD vs. conventional haemodialysis.
Methods: Between April 2010 and June 2013, 93 patients who completed their first year on the NHHD program (out of a total of 186 patients) were included in the study. All patients were on NHHD 3 times/week >7 hours/session. Mean age was 44.3±11.3 years, 33% were female and mean time on NHHD was 19±10 months. The following parameters were evaluated at baseline (while they were on conventional haemodialysis) and at one year after initiation of NHHD: Systolic and diastolic blood pressure, eKt/V, processed blood volume, pre-dialysis creatinine, dry weight, normalized protein catabolic rate (nPCR), phosphate, haemoglobin, phosphate-binder and antihypertensive drug use.
Results: After changing to NHHD, the following significant increases of mean values were observed: eKt/V from 1.4±0.3 to 2.1±0.7, processed blood volume from 86.3±9.0 to 114.9±15.2 L/session, dry weight from 70.9±12.9 kg to 72.3±13.4 kg and nPCR (g/kg/day) from 1.0±0.1 to 1.2±0.1. Pre-dialysis creatinine levels and phosphate levels decreased significantly, haemoglobin and blood pressure remained stable, but phosphate-binder, erythropoietin, and antihypertensive use decreased.
Conclusion/Application to practice: NHHD three times a week for 7-8 hours has led to an improvement in dialysis adequacy and most parameters of nutritional status which might be caused by longer treatment times. Blood pressure and haemoglobin levels remained stable, while phosphate levels decreased despite the reduction of phosphate binders.

Disclosure: No conflict of interest declared

O 48
Who can do home haemodialysis?
S. Cavusoglu Atil¹, G. Kaya Akay¹, L. Haydanli², A. Aykac³, M. Can⁴, I. Hasturk⁵, F. Bilgin⁶, S. Erten², C. Demirci^1
1Ege Nefroloji Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ²Sevgi Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ³Gaziemir Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ⁴Karşıyaka Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ⁵Avcılar 2 Dialysis Center, Fresenius Medical Care, Istanbul, Turkey; ⁶İskenderun Dialysis Center, Fresenius Medical Care, Iskenderun, Turkey

Background: Home haemodialysis provides various advantages such as increased patient flexibility. However, suitability for home haemodialysis is still not clear.

Objectives: Home haemodialysis provides various advantages such as increased patient flexibility. However, suitability for home haemodialysis is still not clear.

Methods: 295 patients from 36 haemodialysis centres were enrolled in a home haemodialysis training programme between April 2010 and July 2013. 85.1% of patients successfully completed the educational programme and started home haemodialysis or were waiting for machine/water treatment system installation to start home HD. Remaining 44 patients (14.9%) left or were asked to leave the home haemodialysis training programme. Demographical and socio-cultural data of these patients were evaluated and data of patients who continued the programme or those who could not complete the educational programme were compared.

Results: There was no apparent correlation between being able to do home haemodialysis and age, gender, educational status. Willingness and participation of the family members in the educational programme had a positive effect on patients. 14.9% could not complete the educational programme, mainly due to unwillingness and lack of support of their families. Other causes were the spatial conditions of their homes and their psychological status (fear of needles, feeling unsafe at home, and anxiety).
2% of patients could not complete the programme due to difficulty or inability to learn.

Conclusion/Application to practice: In our study patient’s and family members’ willingness was the main requirement for home haemodialysis. Age, gender, educational status and vascular access type did not seem to have an effect.

Disclosure: No conflict of interest declared