Rapid high-efficiency hemodialysis

Reductions in treatment time are attractive for patients and dialysis centers. However, there are concerns related to treatment adequacy and increased intradialytic symptoms. Treatment times were progressively reduced in 12 stable patients on standard 4-h acetate hemodialysis, solute clearances being increased proportionately, until the tolerance limit manifested by increased complications or 2.5 h of treatment was reached. Once shortened schedules (mean reduction approximately 31%) were achieved, a 2-month surveillance period was initiated, followed by 2 additional months of bicarbonate therapy, treatment time being unchanged. Rapid bicarbonate hemodialysis was associated with a significantly lower incidence of hypotension, nausea, and vomiting than rapid acetate or standard acetate therapies. Fluid removal was comparable with that of standard treatment, and serum chemistry levels remained stable. Based on the success of these studies treatment times have been reduced in greater than 200 patients with high-efficiency bicarbonate therapy for long-term evaluations.