Long-term hemodialysis at reduced dialysate flow rates

Area of Science:

• Nephrology
• Clinical Medicine
• Biomedical Engineering

Background:

• Dialysate flow rate is a critical parameter in hemodialysis.
• Optimizing dialysate flow can enhance efficiency and reduce costs.
• Previous studies have not extensively evaluated prolonged use of reduced dialysate flow rates.

Purpose of the Study:

• To assess the safety and efficacy of a reduced dialysate flow rate (QD 300 ml/min) in stable hemodialysis patients.
• To determine if prolonged use of QD 300 impacts patient health and dialysis effectiveness.
• To evaluate the economic benefits of reduced dialysate flow.

Main Methods:

• A prospective study involving 20 stable hemodialysis patients.
• Patients were maintained on a dialysate flow rate of 300 ml/min (QD 300) for 24 months.
• Key clinical parameters, laboratory values, and neurological assessments were monitored and compared to a historical QD 500 ml/min group.

Main Results:

• No significant changes were observed in weight, blood pressure, BUN, hematocrit, creatinine, bicarbonate, potassium, cholesterol, or calcium after 24 months on QD 300 compared to QD 500.
• Serum phosphate levels showed a transient increase between months 13-17 but subsequently stabilized.
• No adverse symptoms were reported, and electroencephalograms (EEGs) and motor nerve conduction studies remained normal.

Conclusions:

• A dialysate flow rate of 300 ml/min (QD 300) is safe for prolonged use in stable hemodialysis patients.
• QD 300 maintains dialysis efficiency for the clearance of most small molecules.
• Implementing QD 300 offers a cost saving of $1.38 per patient per dialysis session.