MO916THE EFFECT OF EXTENDED HAEMODIALYSIS ON NUTRITIONAL PARAMETERS: A SYSTEMATIC REVIEW

Abstract Background and Aims Individuals who receive haemodialysis have a high mortality rate, up to 20% within one year of starting dialysis and just under 50% at 5 years. One of the risk factors that contributes to this high mortality rate is the nutritional status of haemodialysis patients; improving this will be a key element of risk mitigation. Extended haemodialysis may improve nutritional outcomes through better clearance and reduced dietary restrictions and medications. The aim of this systematic review is to provide an up to date assessment of trials of extended haemodialysis reporting the following nutritional outcomes: Lean body mass, body mass index, protein intake and energy intake, nutritional status assessed by the subjective global assessment and PEW scores, and circulating markers of appetite. Method No limits on language were set, and databases were searched from inception to December 2020 using a predefined search strategy. Inclusion criteria were; randomised and non-randomised trials of extended haemodialysis (defined by >15 hours per week of total haemodialysis time), with a comparator group which received conventional in-centre haemodialysis (usually <=12 hours per week of hemodialysis time). The following databases were searched: Medline, EMBASE, CINAHL, Cochrane Controlled Register of Trials (CENTRAL), the Web of Science Core Collection,PROSPERO, Clinicaltrials.gov,  the ISCRTN Registry and Conference Proceeding Citation Index, National Health Service Centre for Reviews and Dissemination: Health Technology Assessment (HTA), and Database of Abstracts of Reviews of Effects (DARE).  Additional internet searches (i.e Google Scholar) were also conducted. Search results were compiled in Endnote and studies were screened for title and abstract. Results Searches identified 9251 records. After removing duplicates 6190 records were screened for title and abstract against inclusion criteria, leaving 22 papers for full text screening. A further 17 records were removed following full text screening. Of the remaining 5 papers, one was a randomised controlled trial and four were prospective, non-randomised trials. All studies investigated nocturnal haemodialysis (one with the additional of short daily), three were in-centre and two were at home. Range of duration for the included studies was 2-18 months. Outcomes of interest measured included lean body mass, protein and carbohydrate intake, body mass index, dry lean mass and water soluble vitamin levels. Of these trials, only one reported a statistically significant increase in an outcome of interest (lean body mass). One study also reported cross-sectional data highlighting Vitamin-C deficiency in half of their nocturnal haemodialysis population. Conclusion There is insufficient high-quality evidence assessing the effect of extended haemodialysis on nutritional parameters. Further research is required to understand the impact of novel dialysis prescriptions on these clinical parameters.