Is it useful to increase dialysate flow rate to improve the delivered Kt?

Albalate, Marta; Pérez‐García, Rafael; Sequera, Patricia de; Corchete, Elena; Alcázar, Roberto; Ortega, Mayra; Puerta, Marta

doi:10.1186/s12882-015-0013-9

Cited by 32 publications

(27 citation statements)

References 21 publications

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“…The predictions from the current study are comparable to results from other recent clinical studies suggesting that a dialysate flow rate lower than 500 mL/min has little to no effect on the efficiency of hemodialysis treatments [23,24]. Kashiwagi and colleagues showed that a reduction in the dialysate flow rate from 500 to 400 mL/min at a blood flow rate of 200 mL/min resulted in small decreases in urea clearance that could be compensated by a 5% increase in blood flow rate.…”

Section: Discussionsupporting

confidence: 79%

Differential Molecular Modeling Predictions of Mid and Conventional Dialysate Flows

Leypoldt¹,

Prichard²,

Chertow

et al. 2019

Blood Purif

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Background: High dialysate flow rates (Q_D) of 500–800 mL/min are used to maximize urea removal during conventional hemodialysis. There are few data describing hemodialysis with use of mid-rate Q_D (300 mL/min). Methods: We constructed uremic solute (urea, beta₂-microglobulin and phosphate) kinetic models at varying volumes of distribution and blood flow rates to predict solute clearances at Q_D of 300 and 500 mL/min. Results: Across a range of volumes of distribution a Q_D of 300 mL/min generally yields a predicted urea spKt/V greater than 1.2 during typical treatment times with a small difference in urea spKt/V between a Q_D of 300 and 500 mL/min. A larger urea KoA dialyzer and 15 min of additional time narrows the urea spKt/V difference. No substantial differences were observed regarding the kinetics of beta₂-microglobulin and phosphate for Q_D of 300 vs. 500 mL/min. Conclusion: A Q_D of 300 mL/min can achieve urea clearance targets. Hemodialysis systems using mid-rate Q_D can be expected to provide adequate hemodialysis, as currently defined.

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Section: Discussionsupporting

confidence: 79%

Differential Molecular Modeling Predictions of Mid and Conventional Dialysate Flows

Leypoldt¹,

Prichard²,

Chertow

et al. 2019

Blood Purif

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“…The results of this study show that each of the methods of increasing blood flow rate, increasing fluid flow of dialysis (stepwise profiles) can effectively increase the adequacy of dialysis, while studies by Albalt and Ward showed that increase in fluid flow is not appropriate to increase dialysis adequacy [15,16], and a study by Asef also states that increasing fluid flow in dialysis improves the efficiency of clearance, not increasing blood flow rate [12]. The reason for the difference in these studies is the use of different filters during intervention, however, in our study the same filter was used in routine methods, increase in blood flow and stepwise profile of dialysis fluid flow.…”

Section: Discussionmentioning

confidence: 99%

“…Studies by Yan, Frank, Ward and Hauk [10][11][12][13] also show that increased fluid flow of dialysis can increase dialysis adequacy. However, studies by Azar [14] Ward [15], and Albalate [16] emphasize the low benefits of this method.…”

Section: Biomedical Research 2018; 29 (17): 3389-3394mentioning

confidence: 99%

A comparison of adequacy and complications of hemodialysis: A quasiexperimental study

Haghighi¹,

Rahdar²,

Shad³

et al. 2018

biomedicalresearch

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Background: Hemodialysis, as one of the most commonly used chronic renal failure treatments, increases the level of blood toxins, complications of illness, hospitalized days, imposed costs, and mortality if it does not have the required quality. One of the factors that can be effective in increasing dialysis adequacy in case of patient tolerance and lack of complications is an increasing blood flow, the stepwise profile of dialysis fluid flow. The present study intends to compare these methods in terms of efficiency in increasing the dialysis adequacy against their complications. Materials and methods: In this semi-experimental single-group study, before and after-intervention trials, 22 patients with hemodialysis under the coverage of Special Patients Center in Zabol, who had the criteria to be included in the study were selected by random sampling method and underwent dialysis for 4 sessions using routine methods, increasing blood flow, stepwise profile of dialysis fluid flow, while maintaining all parameters (such as the type of fluid, type and concentration of dialysis fluid, shifts, etc.). At the beginning and the end of the each dialysis session in two methods, the BUN sample was taken before and after dialysis to study the adequacy of dialysis. During the 12 sessions of dialysis, patients were examined before dialysis in terms of lack of hypertension and some symptoms including nausea, vomiting, muscle cramps and other symptoms and then they were monitored directly every 30 min for hypertension, nausea, vomiting, muscle cramps, headaches, and so on. Results: The mean score of adequacy of dialysis was 0.834 ± 0.22 in the routine session, 1.19 ± 0.45 in the method of increasing blood flow and 1.07 ± 0.35 in the stepwise profile of dialysis fluid flow, and there was a significant difference between the mean score of dialysis adequacy in routine session and each method of increasing blood flow and stepwise profiles of dialysis fluid flow using paired t-test (p=0.001). The results from Cochran statistical test showed that there is a significant difference between the routine methods, an increase in blood flow, stepwise profile of dialysis fluid flow profile in terms of the frequency of muscle cramp during hemodialysis (p<0.05) and this difference was statistically significant between the routine session and an increase in blood flow based on McNemar test (p=0.021). Based on the McNamar statistical test, the difference in headache frequency during hemodialysis was significant between the routine session and the stepwise profile of fluid flow (p=0.039). Conclusion: Although the increase in blood flow and dialysis fluid flow in the stepwise method leads to an increase in the adequacy of dialysis, but they are not safe due to their complications and side effects.

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“…Six studies investigated the influence of flow changes on Kt/V [9,20]: five studies showed no significant difference between lower vs higher Qd (400 mL/min vs 500 mL/min or 500 mL/min vs 700 mL/ min); only one study (from Spain) reported a 4% statistically significant increase of Kt between Qd 400 and 500 mL/min and a 2.9% increase from 500 to 700 mL/min [12,24,25]. Two studies focused on clearances for urea and creatinine [24,25] and showed that small solute clearance is highly dependent on dialysate flow rate but only when the dialysate flow rate is much less than 200 mL/min. Four different trials demonstrated that beta-2 microglobulin (beta2MG) clearance was independent of Qd [21,26,27].…”

Section: Effect Of Reduced Dialysis Fluid Flow In Hemodialysis On Watmentioning

confidence: 99%

Eco-dialysis: fashion or necessity

Wieliczko

Zawierucha²,

Covic

et al. 2020

Int Urol Nephrol

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Hemodialysis (HD) is one of the resource hungry medical interventions. A huge volume of water (about 500 L) and significant amounts of energy (over 7 kW) are used for a hemodialysis session; over a kilogram of waste is produced during this procedure. Thus, HD contributes to global warming while saving patients' lives. In this paper, we showed these crucial points in HD treatment and possible ways (e.g. modifications in dialysate flow rate) to reduce environmental impact maintaining therapy standards. Keywords Hemodialysis • Protection of environment • Medical waste management • Natural resource management "After nuclear war, humaninduced global warming is the greatest threat to human life on the planet." Admiral Chris Barrie

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Is it useful to increase dialysate flow rate to improve the delivered Kt?

Cited by 32 publications

References 21 publications

Differential Molecular Modeling Predictions of Mid and Conventional Dialysate Flows

Differential Molecular Modeling Predictions of Mid and Conventional Dialysate Flows

A comparison of adequacy and complications of hemodialysis: A quasiexperimental study

Eco-dialysis: fashion or necessity

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