Clinical observation and nutritional assessment in biofiltration without acetate: three years experience in elderly patients

Acetate free biofiltration (AFB) has been proposed as an alternative method to standard hemodialysis for patients with acetate intolerance, cardiovascular instability and severe metabolic acidosis. Aim of the study is to retrospectively analyze the prevalence of morbidity and mortality in a population of elderly patients treated with AFB (3 and a half hours session). Within a three year period 32 patients have been introduced into our study, mean age 70.5 yrs (range 65-84), dialytic age 72±44 months (range 6-180). Seven of these 32 patients (22%) died, 9 (28%) changed the dialytic method: 4 because of inadequate vascular access, 3 because of method intolerance and 16 (50%) are still under treatment. The average incidence of hospitalization was 7 days patient year. In 13 patients we evaluated the nutritional status and some bio-chemical parameters, comparing the AFB treatment with the preceding one (standard 4 hrs bicarbonate hemodialysis). We did not find any significant difference concerning the metabolic and the nutritional biochemical parameters between the two treatments. During AFB the mean KT/V was 1.08±0.23, calculated PCR was 1.17±0.28 g/Kg/day, with a mean caloric intake of 30±10 Kcal/Kg/day. The body mass index was within normal range, nevertheless an increase in fat mass was present with reduction of fat free mass, confirmed by a reduction of muscle arm area. AFB represents a useful technique for the nephrologist in the treatment of chronic uremia in the elderly. Mainly caloric nutrition, depending inadequate alimentary intake, is frequently observed in the elderly and is not related to reduction of dialytic treatment time.