Smart, Individualized Green Hemodiafiltration - Effects of Individualized Dialysate Flow Through AutoFlow on
Vanessa David1, Bastian Au1, Torsten M Meyer1
1Medical Clinic V, Nephrology, Rheumatology, and Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany.
Introduction:
High-dose online HDF compared with hemodialysis reduces all-cause mortality, but increases water consumption. We postulate that the conundrum could be solved by individualizing dialysate flow.
Methods:
Thirty CKD5D patients undergoing online HDF post-dilution were changed from fixed dialysate flow (500 mL/min) to individualized dialysate flow, resulting in a dialysate flow that was always 20% higher than the blood flow. Kt/V urea, K+, Phos, and pill burden in one quater pre as well as four quarters after the change were evaluated.
Results:
The practice change resulted in a reduction of the fixed dialysate flow from 500 to 360 (240-383) mL/min. Parameters of dialysis adequacy did not change; neither did the medication.
Conclusion:
An individualization of the dialysate flow saved about 36 L dialysate per session; hence, even in light of 23 L used for online HDF, the net burden on the environment could be reduced. Neither dialysis adequacy nor pill burden was negatively affected.
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