Long-Term Online Hemodiafiltration Does Not Reduce the Frequency and Severity of Acquired Cystic Kidney Disease in Hemodialysis Patients

Figures & data

Table 1 Acquired cystic kidney disease (ACKD) severity score, as determined by ultrasonography ACKD severity score

Score	0	1	2	3
Kidney length (cm)	< 9	9–12	12–15	> 15
Size of largest cyst (cm)	0	< 2	2–5	> 5
Number of cysts	0	1–3	4–9	>9
Proportion of noncystic parenchyma	100% (no cysts)	76–99%	25–75%	< 25%

ACKD severity score is the sum of the scores of four components.

The score of each kidney ranges from 0–12; total ACKD severity score ranges from 0–24.

Table 2 Patient demographic data and clinical parameters according to dialysis modalities

	HD (n = 43)	HDF (n = 43)	p value
Age (years)	50 ± 9	51 ± 9	0.871
Gender (M/F)	28/15	28/15	1.000
Duration of RRT (months)	113 ± 49	113 ± 48	0.979
Duration of HDF (months)	0	63 ± 35	NA
Mean arterial pressure (mmHg)	97 ± 2	90 ± 3	0.077
BUN before dialysis (mg/dL)	68 ± 13	64 ± 15	0.307
Serum creatinine (mg/dL)	12.4 ± 1.9	12.2 ± 2.0	0.548
Calcium (mg/dL)	10.3 ± 0.9	9.8 ± 0.7	0.015
Phosphate (mg/dL)	5.3 ± 0.9	5.0 ± 1.2	0.241
Glucose, fasting (mg/dL)	99 ± 38	98 ± 29	0.691
Albumin (g/dL)	4.1 ± 0.2	4.1 ± 0.3	0.291
ALT (U/L)	15.9 ± 9.1	14.0 ± 6.7	0.412
ALK-P (U/L)	82 ± 64	61 ± 17	0.043
Hemoglobin (g/dL)	10.5 ± 0.8	10.5 ± 0.9	0.933
Platelet count (10^3/uL)	203.1 ± 59.6	199.2 ± 59.7	0.779
White cell count (10^3/uL)	6.58 ± 1.38	6.35 ± 1.52	0.477
Ferritin (ng/mL)	303 ± 302	241 ± 226	0.323
iPTH (pg/mL)	544 ± 649	282 ± 218	0.039
Body mass index (kg/m^2)	21.8 ± 2.3	22.4 ± 3.0	0.358
Residual GFR (mL/min)	0.9 ± 1.9	0.5 ± 1.7	0.529
Urea reduction ratio	0.76 ± 0.05	0.79 ± 0.05	0.018
KT/Vurea	1.73 ± 0.27	1.89 ± 0.30	0.012
nPCR (g/kg/day)	1.26 ± 0.34	1.21 ± 0.37	0.505
hs-CRP (mg/L)	6.57 ± 10.08	4.11 ± 5.93	0.132

*p < 0.05.

Data are means ± SD.

Abbreviations: NA = not applicable, RRT = renal replacement therapy, HDF = hemodiafiltration, BUN = blood urea nitrogen, ALT = alanine aminotransferase, ALK-P = alkaline phosphatase, iPTH = intact parathyroid hormone, GFR = glomerular filtration rate, nPCR = normalized protein catabolic rate, hs-CRP = high-sensitivity C-reactive protein.

Figure 1. Comparison of the severity of ACKD in patients treated with HD or online HDF and assessment of the severity of ACKD. (A) ACKD severity scores in HD patients (n = 43) and HDF patients (n = 43). (B) Kidney length in HD patients (n = 86) and HDF patients (n = 86). (C) Size of the largest cyst in HD patients (n = 86) and HDF patients (n = 86). (D) ACKD severity scores in patients with ACKD (n = 44) and without ACKD (n = 42). (E) Kidney length in ACKD patients (n = 88) and non-ACKD patients (n = 84). (F) Size of the largest cyst in ACKD patients (n = 67) and non-ACKD patients (n = 72).

Figure 2. Correlation between duration of renal replacement therapy (RRT) and ACKD severity score.

Table 3 Clinical parameters of patients with ACKD and without ACKD

	Non-ACKD(n = 42)	ACKD (n = 44)	p value
HD/HDF	20/22	23/21	0.829
Sex (M/F)	26/16	30/14	0.652
Age (years)	50 ± 10	51 ± 7	0.786
Duration of RRT (months)	88 ± 41	138 ± 42	<0.001^‡
Mean arterial pressure (mmHg)	95 ± 2	93 ± 3	0.474
BUN before dialysis (mg/dL)	67 ± 16	66 ± 13	0.738
Serum creatinine (mg/dL)	12.2 ± 1.9	12.4 ± 2.0	0.532
Calcium (mg/dL)	10.1 ± 0.8	10.1 ± 0.8	0.685
Phosphate (mg/dL)	5.2 ± 1.1	5.1 ± 1.0	0.509
Glucose, fasting (mg/dL)	100.1 ± 42.1	95.3 ± 23.0	0.759
Albumin (g/dL)	4.1 ± 0.3	4.1 ± 0.2	0.948
ALT (U/L)	15 ± 9	15 ± 8	0.789
ALK-P (U/L)	77 ± 64	65 ± 23	0.489
Hemoglobin (g/dL)	10.4 ± 0.9	10.5 ± 0.9	0.625
Ferritin (ng/mL)	302 ± 318	243 ± 207	0.701
iPTH (pg/mL)	411 ± 626	416 ± 344	0.159
Body massindex (kg/m^2)	22.7 ± 2.9	21.5 ± 2.4	0.043
Residual GFR (mL/min)	1.4 ± 2.5	0.1 ± 0.3	0.003^†
Urea reduction ratio	0.77 ± 0.06	0.78 ± 0.04	0.402
KT/Vurea	1.79 ± 0.34	1.83 ± 0.25	0.516
nPCR (g/kg/day)	1.22 ± 0.35	1.24 ± 0.36	0.803
hs-CRP (mg/L)	5.13 ± 5.11	5.54 ± 10.57	0.155

*p < 0.05, ^†p < 0.01, ^‡p < 0.001.

Data are means ± SD.

Abbreviations: NA = not applicable, RRT = renal replacement therapy, HD = hemodialysis, HDF = hemodiafiltration, BUN = blood urea nitrogen, ALT = alanine aminotransferase, ALK-P = alkaline phosphatase, iPTH = intact parathyroid hormone, GFR = glomerular filtration rate, nPCR = normalized protein catabolic rate, hs-CRP = high-sensitivity C-reactive protein.

Table 4 Multivariate logistic regression analysis of risk factors for ACKD

		95.0% CI for odds ratio
Characteristic	Odds ratio	Lower	Upper	p value
Age (years)	1.012	0.952	1.075	0.703
Male gender	2.958	0.878	9.971	0.080
HDF	1.431	0.499	4.104	0.505
Duration of RRT (months)	1.025	1.010	1.041	0.001
Residual GFR (mL/min)	0.564	0.235	1.354	0.200
Body mass index (kg/m^2)	0.954	0.778	1.170	0.650

*p < 0.01.

Abbreviations: RRT = renal replacement therapy, HDF = hemodiafiltration, GFR = glomerular filtration rate.