Toward Green Dialysis: Efficacy and Sustainability with Reduced Dialysate Flow in Expanded Hemodialysis

Introduction: Reducing dialysate flow (Qd) to 400 mL/min has proven to be sufficient, safe, and effective in meeting dialysis adequacy requirements in adults, with the added advantage of decreasing water consumption per dialysis session. Expanded hemodialysis (HDx), which uses dialyzers with membranes capable of enhanced clearance of medium-sized molecules due to expanded pore capacity, has higher efficiency and reduces the importance of the dialysate-to-blood flow ratio (Qd/Qb) for molecule removal. The objective of this study was to evaluate dialysis effectiveness by analyzing the reduction rate of medium-sized molecules in patients weighing ≤70 kg, comparing Qd 400 mL/min vs. 500 mL/min in HDx using Theranova® membrane.

A post hoc analysis of the COREXH study population was performed. This observational, analytical, retrospective cohort study included 23 patients, of whom 11 (47%) had Qd 400 mL/min and 12 (52.1%) had Qd 500 mL/min.

No statistically significant differences were observed in the reduction rate of medium-sized molecules between the Qd 400 mL/min and 500 mL/min groups. Additionally, water consumption was lower in the Qd 400 mL/min group, with an average saving of 24 L per patient per session and 13,824 L over 12 weeks.

Using Qd 400 mL/min in HDx vs. 500 mL/min did not affect dialysis effectiveness in terms of molecule reduction rates and resulted in substantial water savings in Qd 400 mL/min group.