Abstract Background and Aims Short daily home hemodialysis (HDD) with low dialysate flow rate has been shown in recent years as an attractive alternative for portable dialysis home use. Although the effectiveness of the technique for volume control and elimination of small solutes and middle molecules has been demonstrated, data are scarce for the elimination of protein-bound uremic toxins. The aim of this study was to compare the reduction ratios (RRs) of p-cresol sulfate (pCS) and indoxyl sulfate (IS) in the Physidia HHD system with high-volume online-hemodiafiltration (OL-HDF) treatment. Methods In an open, randomized, cross-over, single-center, controlled study, 40 adult chronic HD patients were treated with a 2.5 h-length HD session with low dialysate flow rate with the Physidia HDD system, and a 4 h-length OL-HDF session in post-dilution mode during two successive weeks. During the sessions, pre-HD and post-HD plasma samples were collected and single and weekly RRs of pC and IS were intraindividually compared for the two dialysis types with linear mixed models. Results Whereas single-session RRs of p-CS and IS were similar in both groups, weekly RRs of both protein-bound uremic toxins were significantly higher with the short-daily HDD Physida system than those obtained with OL-HDF (Table 1). Conclusion The short-daily home hemodialysis using low dialysate flow rate with the Physidia system appears to be a potential technologic step ahead in terms of improved protein-bound uremic toxins removal for dialysis patients, and might contribute to a more adequate dialysis therapy than in-center high-volume online-hemodiafiltration (OL-HDF) treatment.

Abstract Background and Aims Hemodiafiltration with regeneration of the ultrafiltrate (HFR) is a highly biocompatible dialysis technique that combines convection, diffusion, and adsorption. SUPRA-H is a new HFR system which uses a high-flux dialyzer in the diffusive stage to improve large uremic toxin removal. The aim of our study was to compare the toxin removal of the SUPRA-H system with high-volume online-hemodiafiltration (OL-HDF). Method In an open, randomized, cross-over, single-center, controlled study, 16 adult chronic hemodialysis patients were treated with SUPRA-H or OL-HDF. Hemodialysis sessions were delivered with Flexya dialysis monitor (Medtronic) in the middle-week session, lasting four hours. OL-HDF session was performed in post-dilution mode with the same high-flux dialyzer (Phylter HF17G, Medtronic) as that used in the diffusive stage of the SUPRA-H system. All other dialysis parameters were kept constant in both study arms. The reduction rate (RR) of urea, creatinine, phosphate, β2-microglobulin (β2mglob), kappa (κFLC) and lambda (λFLC) free light chains, interleukin-6 (IL-6) p-Cresyl sulfate, indoxyl sulfate and albumin, was intraindividually compared for the two dialysis types with linear mixed models. Results Whereas urea RR was significantly lower, SUPRA-H had significantly higher RR for κFLC (Median: 58.63%, IQR: 49.91-70.24) than those obtained with OL-HDF (Median: 51.97%, IQR: 37.12-62.71); p = 0.03). The RRs for the other large and protein-bound uremic toxins tended to be higher with the SUPRA-H system (Figure 1). There were no significant differences in the RRs for creatinine, phosphate, IL-6, and albumin. Conclusion The new HFR system SUPRA-H, appears to be a potential technologic step ahead in terms of improved large molecule removal for dialysis patients, and might contribute to a more adequate dialysis therapy.

Rationale and objective: Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney disease (NDD-CKD) patients has been uncertain. Study design: Our research is presented in a prospective cohort study. Setting and participants: A total of 966 participants with NDD-CKD stages 4-5 were enrolled in the PECERA study from 12 centers in Spain. Exposure: The participants were treated with sevelamer. Outcome: This study yielded all-cause and cardiovascular mortality outcomes. Analytical approach: We conducted an association analysis between mortality and sevelamer use with time-dependent Cox proportional hazards models. Results: After a median follow-up of 29 months (IQR: 13-36 months), death occurred in 181 participants (19%), with cardiovascular (n = 95, 53%) being the leading cause of death. In a multivariable model, the adjusted hazard ratios (HRs) for patients under sevelamer treatment were 0.44 (95% CI, 0.22 to 0.88) and 0.37 (95% CI, 0.18 to 0.75) for all-cause and cardiovascular mortality, respectively, compared with those of untreated patients. Limitations: Some limitations include potential confusion via indication bias; causal statements about these associations cannot be made due to the observational nature of this study. Conclusions: In this prospective NDD-CKD cohort study, the administration of sevelamer was independently associated with lower all-cause and cardiovascular mortality, suggesting that non-calcium-based phosphate binders might be the first-line therapy for phosphate lowering in this population. Further interventional studies clarifying the risks and benefits of phosphate binders in NDD-CKD are warranted.

Home hemodialysis (HHD) with low-flow dialysate devices has gained popularity in recent years due to its simple design, portability, and ability to provide greater freedom of movement for our patients. However, there are doubts about the adequacy that this technology offers, since it uses monitors with low-flow bath and lactate. The aim of this study was to demonstrate the clinical benefits of low-flow HHD with the NxStage System One® recently introduced in Spain. We present the results of an observational, retrospective cohort study that included the first patients who started short daily HHD with this device in 12 Spanish centers. We analyzed the evolution of 86 patients at 0, 6 and 12 months, including data related to prescription, and evolution of biochemical parameters related to dialysis dose, anemia, mineral-bone metabolism; evolution of residual renal function, medication usage, and causes of withdrawal during the followup. We were able to demonstrate that this NxStage System One® monitor, in patients with HHD, have provided an adequate dialysis dose, with optimal ultrafiltration rate, with improvement of main biochemical markers of dialysis adequacy. The usage of this technique was associated to a decrease of antihypertensive drugs, phosphate binders and erythropoietin agents, with very good results both patient and technique survival. The simplicity of the technique, together with its good clinical outcomes, should facilitate the growth and utilization of HHD, both in incident and prevalent patients.

Abstract BACKGROUND AND AIMS HFR-Supra (haemodiafiltration with the regeneration of the ultrafiltrate) is a highly biocompatible dialysis technique characterized by an adsorptive resin cartridge with high protein-bound toxin adsorption capacity without removal of albumin, mimicking both glomerular and tubular functions. However, the low-flux dialyzer contained in the second diffusive stage of the HFR Supra system may hamper the removal of large uraemic toxins. This study assessed the large uraemic toxin removal ability of a new HFR system (HFR-H) which combines adsorption such as in HFR-Supra, with a high-efficiency high-flux haemodialysis membrane. METHOD In an open, randomized, cross-over, single-center, controlled study, 16 adult chronic haemodialysis patients were treated by haemodiafiltration with the regeneration of the ultrafiltrate with the HFR-Supra or the HFR-H system. All other dialysis parameters were kept constant in both study arms. All the treatments were delivered with Flexya dialysis monitor (Medtronic) in the middle-week session, lasting 4-h. The reduction rate (RR) of urea, creatinine, phosphate, β2-microglobulin, kappa (κFLC) and lambda (λFLC) free light chains and albumin, was intra-individually compared for the two dialysis types with linear mixed models. RESULTS The RRs for β2-microglobulin, κFLC and λFLC were significantly higher with the HFR-H system than those obtained with HFR-Supra (Figure). There were no significant differences in the RR for urea, creatinine, phosphate, interleukin-6 and albumin. CONCLUSION This study demonstrates that treating patients with an HFR-H instead of an HFR-Supra system significantly increases the elimination of middle and large molecules.

Abstract BACKGROUND AND AIMS The present study tested the hypothesis that short daily home haemodilaysis (HDD) with low flow dialysate using the NxStage monitor (Fresenius Medical Care) could preserve muscle mass and prevent protein-energy wasting in HD patients, despite using low-flux, lactate-buffered dialysate. METHOD This 12-month, prospective, controlled study examined 25 consecutive, non-selected CKD stage 5 patients who initiated short daily HHD with low-flow dialysate (HHD group) in our centre, and were compared with data from 50 patients on high-flux HD (HF-HD group) and 50 patients on on-line haemodiafiltration (OL-HDF group) obtained from the Fresenius Medical Care clinical database EuCliD after matching for clinical characteristics and propensity scores. Changes in body composition were assessed by whole-body bioimpedance spectroscopy (BIS; Fresenius Medical Care) at baseline, months 3, 6 and 12, by experienced research staff blinded to all clinical and biochemical data of the patients. In order to control for potential variability and the effect of overhydration, all BIS analyses were performed before a mid-week dialysis session. Linear mixed-effects models were used for the analysis of the repeated measures data. RESULTS Compared with in centre HF-HD, patients assigned to HHD experienced a gradual improvement in LTM. These differences reached statistical significance at Month 6 and Month 12, with a relative difference of 2.76 kg [95% confidence interval (95% CI): 0.53–4.99; P = 0.01] and 3.08 kg (95% CI: 0.68–5.45; P = 0.01), respectively. Changes in fat inversely mirrored those of LTM, with a relative difference between groups of –3.29 kg (95% CI: –6.66–0.07; P = 0.05) at Month 12. No differences in hydration status or dry weight were noted between groups (Table 1). No significant changes in body composition were observed between the HDD and the OL-HDF groups (data not shown). CONCLUSION Short daily HHD with the NxStage system for 1 year compared with HF-HD increased muscle mass, supporting the hypothesis that short daily HHD with low-flow dialysate could benefit nutritional status and prevent protein-energy wasting in HD patients.

The search of separation hyperplanes is an efficient way to find rules with classification purposes. This paper presents an alternative mathematical programming formulation to existing methods to find a discriminant hyperplane. The hyperplane H is found by minimizing the sum of all the distances to the area assigned to the group each individual belongs to. It results in a convex optimization problem for which we find an equivalent linear programming problem. We demonstrate that H exists when the centroids of the two groups are not equal. The method is effective dealing with low and high dimensional data where reduction of the dimension is proposed to avoid overfitting problems. We show the performance of this approach with different data sets and comparisons with other classifications methods. The method is called LPDA and it is implemented in a R package available in https://github.com/mjnueda/lpda.

Abstract BACKGROUND AND AIMS Use of phosphate binders among non-dialysis chronic kidney disease (ND-CKD) patients remains controversial, since clinically relevant benefits have not been fully demonstrated. The goal of this study was to determine patterns of phosphate binders use and its associated outcomes in ND-CKD patients. METHOD PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicentre, open-cohort study of 966 adult patients with non-dialysed CKD stages 4–5 enrolled from 12 centres in Spain. The end of the follow-up was December 2012. At baseline and every 6 months, demographics, comorbidities, treatments and serum biochemical parameters were collected. Patients who received treatment with calcium-based and calcium-free phosphate binders were compared with those who had not. In a prespecified statistical approach, we assessed the association of phosphate binders use with all-cause mortality using time-dependent Cox proportional hazards models. RESULTS Sevelamer was the only calcium-free based binder prescribed during the study. Overall, 515 (53%) patients received some form of binder, with most of them using calcium-based binders (n = 360, 37%) and a minority (n = 111, 11%) using exclusively sevelamer (n = 111, 11%) or a combination of the two (n = 44, 5%). After a median follow-up of 29 months (IQR 13–36 months) there were 181 deaths (19%). Crude overall all-cause mortality was significantly lower in patients receiving sevelamer, but not in those receiving calcium-based binders (Figure). After multivariate adjustment for age, weight, blood pressure, diabetes, comorbidity, vitamin D treatment, renal function and levels of albumin, calcium, phosphorous and PTH, treatment with sevelamer was independently associated with lower mortality [adjusted hazard ratio (HR), 0.44 (95% confidence interval (95% CI), 0.22–0.88); P = 0.02]. Use of calcium-based phosphate binders did not predict death. CONCLUSION The administration of sevelamer is associated with lower all-cause mortality in advanced ND-CKD patient. Clinical trials are warranted to clarify the risks and benefits of phosphate binders in this population.

Abstract BACKGROUND AND AIMS Portable haemodialysis (HD) systems with a low dialysate flow rate in a short frequent schedule have become an attractive option for patients on home HD (HHD). Although these systems have been demonstrated to be effective for removing low weight molecular uraemic toxins, there are few data on their removal ability of higher molecular weight toxins. This study assessed the uraemic toxin removal ability of the portable Physidia S3 Monitor in a short, frequent, 5 days/week, low-dialysate flux HHD versus 3 days/week, in centre online haemodiafiltration (OL-HDF). METHOD In an open, randomized, cross-over, single-centre, controlled, prospective study, 40 adult chronic HD patients were treated by a 2.5-h low flux dialysate HD session or a 4-h post-dilution OL-HDF. All other dialysis parameters including dialyzer (polysulfone high-flux dialyzer NS 1.8, Toray®) were kept constant in both the study arms. The weekly reduction rate (RR) and the weekly eliminated mass into dialysate (EM) of urea, creatinine, phosphate, β2-microglobulin, kappa (κFLC) and lambda (λFLC) free light chains and albumin, were intra-individually compared for the two dialysis types with linear mixed models. RESULTS There were no significant differences in the RR for urea, phosphate, κFLC and albumin, whereas the weekly RRs for creatinine and β2-microglobulin were significantly higher with the Physidia S3 system than those obtained with OL-HDF (Table). Only the λFLC RR was significantly higher with OL-HDF. Similar results were observed when weekly EMs were compared (data not shown). CONCLUSION This study demonstrates that treating patients with low flow dialysate HHD in a short frequent schedule with Physidia S3 system, instead of 3 days/week, in-centre OL-HDF, significantly increases the weekly elimination of β2-microglobulin, enabling an adequate clearance of small and large uraemic toxins.

Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicenter, open-cohort study of 966 adult patients with non-dialyzed CKD stages 4–5 enrolled from 12 centers in Spain. Associations between levels of serum calcium (Ca) (corrected for albumin), phosphate (P), and intact parathyroid hormone (iPTH) with all-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical values collected every 6 months for 3 years. After a median follow-up of 29 months (IQR: 13–36 months) there were 181 deaths (19%). The association of calcium with all-cause mortality was J-shaped, with an increased risk for all-cause mortality at levels > 10.5 mg/dL. For phosphate and iPTH levels, the association was U-shaped. The serum values associated with the minimum risk of mortality were 3.8 mg/dL for phosphate and 70 pg/mL for iPTH, being the lowest risk ranges between 2.8 and 5.0 mg/dL, and between 38 and 112 pg/mL for phosphate and iPTH, respectively. Our study provides evidence on the non-linear association of serum calcium, phosphate and iPTH levels with mortality in stage 4 and 5 CKD patients, and suggests potential survival benefits for controlling bone mineral parameters in this population, as previously reported for dialysis patients.

Dialytic clearance of p-cresyl sulfate (pCS) and other protein-bound toxins is limited by diffusive and convective therapies, and only a few studies have examined how to improve their removal by adsorptive membranes. This study tested the hypothesis that high-flux polymethylmethacrylate (PMMA) dialysis membranes with adsorptive capacity increase pCS removal compared to polysulfone membranes, in a postdilution on-line hemodiafiltration (OL-HDF) session. Thirty-five stable hemodialysis patients randomly completed a single study of 4 h OL-HDF with PMMA (BG2.1U, Toray®, Tokyo, Japan) and polysulfone (TS2.1, Toray®) membranes. The primary endpoint was serum pCS reduction ratios (RRs) obtained with each dialyzer. Secondary outcomes included RRs of other solutes such as β2-microglobulin, the convective volume obtained after each dialysis session, and the dialysis dose estimated by ionic dialysance (Kt) and urea kinetics (Kt/V). The RRs for pCS were higher with the PMMA membrane than those obtained with polysulfone membrane (88.9% vs. 58.9%; p < 0.001), whereas the β2-microglobulin RRs (67.5% vs. 81.0%; p < 0.001), Kt (60.2 ± 8.7 vs. 65.5 ± 9.4 L; p = 0.01), Kt/V (1.9 ± 0.4 vs. 2.0 ± 0.5; p = 0.03), and the convection volume (18.8 ± 2.8 vs. 30.3 ± 7.8 L/session; p < 0.001) were significantly higher with polysulfone membrane. In conclusion, pCS removal by OL-HDF was superior with high-flux PMMA membranes, appearing to be a good dialysis strategy for improving dialytic clearance of pCS, enabling an acceptable clearance of β2-microglobulin and small solutes.

Down syndrome (DS) is related to diseases like congenital heart disease, obstructive sleep apnea, obesity and overweight. Studies focused on DS associated with obesity and overweight are still scarce. The main objective of this work was to analyze the relationship between dietary intervention, physical exercise and body composition, in DS with overweight and obesity. This review is based on the PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Selection criteria for this analysis were: publications between January 1997 and December 2019; DS individuals with overweight and obesity; clinical trials using dietary intervention and physical exercise paying attention to changes in body composition. Selected clinical trials were focused on an exclusive intervention based on physical exercise. The anthropometric measures analyzed were body fat, BMI, waist circumference, body weight and fat free mass. The main conclusion is that prescribing structured physical exercise intervention may be related to a greater variation in body composition. Despite limited number of clinical trials analyzed, it can be assumed that the reported studies have not achieved optimal results and that the design of future clinical trials should be improved. Some guidelines are proposed to contribute to the improvement of knowledge in this field.

Abstract Background and Aims Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). Method PECERA (Collaborative Study Project in Patients with Advanced Chronic Kidney Disease) is a 3-year, multicentre, open-cohort, prospective study carried out in 995 adult patients with CKD stages 4-5 not on dialysis enrolled in 2007-09 from 12 centres in Spain. Associations between levels of serum calcium (corrected for serum albumin), phosphate, and intact parathyroid hormone (iPTH) and all-cause mortality were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical collected at baseline and every 6 months for 3 years. Results After a median follow-up of 30 months (IQR:14-37 months) there were 180 deaths (18%). The association of calcium and phosphate with all-cause mortality was U-shaped (Figure). The serum values associated with the minimum risk of mortality were 9.35 mg/dL for calcium and 3.56 mg/dL for phosphate, being the lowest risk ranges between 7.4 to 10.7 mg/dL and between 2.3 to 4.6 mg/dL for calcium and phosphate, respectively. For iPTH levels, the association was J-shaped, with an increased risk for all-cause mortality at levels > 110 pg/mL. Conclusion As previously reported in dialysis patients, PECERA provided evidence on the association of serum calcium, phosphate and iPTH levels with all-cause mortality in stage 4 and 5 CKD patients, suggesting potential survival benefits of controlling bone mineral parameters in this population. Whereas the ranges of calcium and phosphate associated with the lowest mortality in the study were consistent with the current K-DIGO guidelines, our results suggested that the threshold for considering anti-parathyroid treatment might be lower than is currently recommended.

Desde que el grupo de divulgacion de las matematicas Dimates se constituyo en la UA, muchas y diversas han sido las actividades realizadas para difundir la presencia de las matematicas que encontramos cada dia, transmitir la utilidad de su estudio y de sus aplicaciones y mejorar el conocimiento que de ellas tienen nuestros alumnos, tanto los estudiantes del Grado en Matematicas, de la Facultad de Educacion o de la Facultad de Derecho, como aquellos estudiantes de Ciencias para los que las matematicas es una herramienta basica. A lo largo de los anos el tipo de actividades ha ido evolucionando: desde las mas tradicionales (conferencias, presentaciones de libros, cursos presenciales, etc.) hasta la incorporacion al mundo virtual a traves de nuestra presencia en las redes sociales y el diseno de actividades no presenciales que pueden ser realizadas a traves de dispositivos electronicos. El objetivo de la red durante este curso sera recoger las nuevas actividades realizadas, sus caracteristicas y mostrar la repercusion que estas han podido tener.

(1) Objective: to establish practical guidance for the design of future clinical trials in MS (metabolic syndrome) patients aged 18 and older, based on a systematic review of randomized clinical trials connecting diet, physical exercise and changes in body composition. (2) Method: this systematic review of randomized clinical trials (RCT) is based on the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Criteria of selection: ≥18 years of age; patients diagnosed with MS; intervention programs including diet, physical exercise and/or modifications in the style of life as treatment, as well as the magnitude of changes in body composition (BC); randomized clinical trial published between 2004 and 2018. (3) Results: the multidisciplinary interventions describe major changes in BC, and the recurring pattern in these clinical trials is an energy reduction and control in the percentage of intake of macronutrients along with the performance of regularly structured exercise; the most analyzed parameter was waist circumference (88.9% of the trials), followed by body weight (85.2%), BMI (77.8%) and body fat (55.6%). (4) Conclusions: The analysis of the information here reported sheds light for the design of future clinical trials in adults with MS. The best anthropometric parameters and units of measurement to monitor the interventions are related to dietary and physical exercise interventions. A list of practical advice that is easy to implement in daily practice in consultation is here proposed in order to guarantee the best results in changes of body composition.

Objective: To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS). Method: search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition). Results: 1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m2 and BW (body weight) in kg. Conclusions: Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.

7.05 mg/mL, P¼0.001), and residual glomerular filtration rate (rGFR), derived from cystatin C formula (median: 2.66 vs 2.43 mL/min/1.73m 2 , P¼0.001).CONCLUSIONS: Our data suggest that ESRD patients under chronic dialysis and under diuretic therapy have a decreased inflammatory response, lower levels of BTP and D-dimers.These beneficial changes could contribute to improve the outcomes of these patients.

Background Compared with conventional haemodialysis (HD), online haemodiafiltration (OL-HDF) achieves a more efficient removal of uraemic toxins and reduces inflammation, which could favourably affect nutritional status. We evaluate the effect of OL-HDF on body composition and nutritional status in prevalent high-flux HD (HF-HD) patients. Methods In all, 33 adults with chronic kidney disease (CKD) Stage 5 undergoing maintenance HF-HD were assigned to post-dilution OL-HDF (n = 17) or to remain on HF-HD (n = 16, control group) for 12 months. The primary outcome was the change in lean tissue mass (LTM), intracellular water (ICW) and body cell mass (BCM) assessed by multifrequency bioimpedance spectroscopy (BIS) at baseline and 4, 8 and 12 months. The rate of change in these parameters was estimated with linear mixed-effects models. Results Compared with OL-HDF, patients assigned to HF-HD experienced a gradual reduction in LTM, ICW and BCM. These differences reached statistical significance at Month 12, with a relative difference of 7.31 kg [95% confidence interval (CI) 2.50-12.11; P = 0.003], 2.32 L (95% CI 0.63-4.01; P = 0.008) and 5.20 kg (95% CI 1.74-8.66; P = 0.004) for LTM, ICW and BCM, respectively. The normalized protein appearance increased in the OL-HDF group compared with the HF-HD group [0.26 g/kg/day (95% CI 0.05-0.47); P = 0.002], with a relative reduction in high-sensitive C-reactive protein [-13.31 mg/dL (95% CI -24.63 to -1.98); P = 0.02] at Month 12. Conclusions OL-HDF for 1 year compared with HF-HD preserved muscle mass, increased protein intake and reduced the inflammatory state related to uraemia and dialysis, supporting the hypothesis that high convection volume can benefit nutritional status and prevent protein-energy wasting in HD patients.