Background: Online hemodiafiltration (OHDF), which results in high albumin leakage, is now widely used in Japan for dialysis, since the national insurance system began reimbursing its costs in 2012. Glycated albumin (GA) levels are affected by albumin leakage into effluent dialysate fluid. Therefore, GA levels in patients requiring diabetesrelated dialysis undergoing OHDF require monitoring. However, there have been no previous reports on glycemic control indicators of patients with diabetes undergoing OHDF. We aimed to develop a glycemic control index for patients requiring diabetes-related dialysis undergoing OHDF. Methods: This study comprised 133 diabetic patients undergoing OHDF. We examined the correlation between GA and glycated hemoglobin (HbA1c) levels. We analyzed effluent dialysate fluid samples from 41 patients classified into 3 groups, namely, group A, non-protein-leaking OHDF (n = 20); group B, protein-leaking OHDF (n = 14); and group C, highly efficient protein-leaking OHDF (n = 7). We examined the association between GA and HbA1c levels in each group and among patients. Results: A significant positive correlation was observed between GA and HbA1c levels (r = 0.562, p < 0.0001). There was no significant correlation between pre-dialysis blood glucose levels and HbA1c or GA levels as observed on regular blood tests performed under non-fasting conditions. Patients were classified into 2 groups based on their mean albumin levels (3.4 g/dL cutoff). The correlation between HbA1c and GA levels was found to be weaker in the 51 patients with mean albumin levels < 3.4 g/dL (r = 0.399, p = 0.0037) than in the 82 patients with mean albumin levels ≥ 3.4 g/dL (r = 0.674, p < 0.0001). When the hemodiafilter performance was assessed, no correlation was observed between HbA1c and GA levels in group C patients. Conclusions: GA levels may be underestimated in patients undergoing OHDF because of the effect of albumin leakage into the effluent dialysate fluid. If a stable hemoglobin value can be maintained during OHDF therapy, then GA and HbA1c levels should be used as a glycemic control index for patients requiring diabetes-related dialysis, considering the dialysis treatment method and protein permeability of the dialyzers and hemodiafilters.

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Background We compared amino acid leakage among high-volume pre-dilution on-line hemodiafiltration (Pre O-HDF), hemodialysis (HD), and post-dilution on-line hemodiafiltration (Post O-HDF). Subjects and methods The subjects were 9 patients. For HD, the total dialysate flow rate was established as 500 mL/min. For high-volume Pre O-HDF, it was established as 600 mL/min, under a replacement fluid volume of 90 L. For Post O-HDF, it was established as 600 mL/min, under a replacement fluid volume of 10 L. In both procedures, the duration of treatment was 4 h, and the blood flow volume was 200 mL/min. We compared the leakages of total amino acid, non-essential amino acid, and essential amino acid, clear spaces (CSs), β2-microglobulin (β2-MG) reduction rate, Kt/V for urea, and albumin leakage among the three procedures. Results Amino acid leakages after high-volume Pre O-HDF were significantly lower than HD and Post O-HDF. The CSs after high-volume Pre O-HDF were significantly lower than Post O-HDF. The β2-MG reduction rate after high-volume Pre O-HDF was significantly lower than Post O-HDF. The Kt/V for urea was not significantly different. Albumin leakages were below the detection limit (< 1 g) in the three procedures. Conclusion Under the treatment conditions we performed this time, high-volume Pre O-HDF reduces amino acid leakage in comparison with HD and Post O-HDF. High-volume Pre O-HDF is a therapeutic mode that suppresses amino acid leakage.

Keywords： outpatient hemodialysis clinic, COVID-19, prevention of secondary infections, standard precautions recommended in dialysis-related societies' guidelines, dialysis with cohort isolation 〈Abstract〉 Our outpatient maintenance hemodialysis clinic, which does not have any beds, is located in Kanagawa Prefec

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