Thrice-Weekly Nocturnal In-Centre Haemodiafiltration: A 2-Year Experience

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Technology

Background:

• Achieving adequate plasma phosphate control is challenging with standard thrice-weekly hemodialysis.
• Phosphate binders are often necessary but can be burdensome for patients.
• Alternative strategies are needed for effective phosphate management in hemodialysis settings.

Purpose of the Study:

• To evaluate the efficacy of extended-hour haemodiafiltration in managing plasma phosphate levels.
• To assess the feasibility of eliminating phosphate binders in patients undergoing thrice-weekly in-centre dialysis.
• To determine if small-solute clearance can be improved by combining convection with extended dialysis hours.

Main Methods:

• A prospective analysis of 14 patients' electronic records over two years.
• Increasing haemodiafiltration duration from 4.5 to 8 hours per session.
• Monthly review of dialysis adequacy, biochemical parameters, and medication, with discontinuation of phosphate binders.

Main Results:

• Significant reduction in pre-dialysis plasma phosphate levels (1.52 to 1.06 mmol/l).
• Complete elimination of phosphate binder intake (average 3.26 tablets daily).
• Normal plasma phosphate levels maintained with increased dietary phosphate and no supplementation.

Conclusions:

• Thrice-weekly in-centre haemodiafiltration can achieve adequate phosphate control.
• Phosphate binders and intradialytic supplementation are not required with this approach.
• Extended-hour haemodiafiltration offers a viable alternative for phosphate management in hemodialysis.