The impact of blood flow rate during hemodialysis on all-cause mortality

Chang, Kyung Yoon; Kim, Su Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong Lim; Kim, Yon Su; Kang, Shin Wook; Kim, Nam Ho; Yang, Chul Woo; Kim, Yong Kyun

doi:10.3904/kjim.2015.111

Cited by 26 publications

(23 citation statements)

References 14 publications

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“…Our study is also in agreement with the study of Borzuo et al in terms of effective improvement of dialysis adequacy by interfering with increase in blood flow. Chang et al also found that patients with a blood flow greater than 250 ml/min had higher dialysis adequacy than patients with a blood flow rate of 250 ml/min [27]. A study by Gutzwiller entitled "Increasing blood flow increases kt/V (urea) and potassium removal" but fails to improve phosphate removal" is also in agreement with our study in terms of significant increase in the adequacy of dialysis with increase in blood flow.…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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

Haghighi¹,

Rahdar²,

Shad³

et al. 2018

biomedicalresearch

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“…The rate of metabolite's diffusion increased by high BFR. As a result, electrolytes and poisons were more quickly removed from the blood flow, which ultimately increased hemodialysis adequacy (36)(37)(38)(39). Previous studies showed that increase of both BFR and the hemodialysis flow rate increased hemodialysis adequacy in an effective manner.…”

Section: Discussionmentioning

confidence: 99%

How to increase dialysis adequacy; A randomized clinical trial

et al. 2019

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Introduction: Studies have shown when hemodialysis treatment is sufficiently effective, complications of uremic syndrome, additional treatment costs and hospitalization length are reduced. Several methods have been proposed to improve hemodialysis adequacy. Objectives: In this study, the effects of the synchronic use of the stepwise profile dialysis fluid flow rate with increased blood flow rate (BFR) were studied on hemodialysis adequacy. Patients and Methods: This is a cross-over clinical trial study conducted on 34 hemodialysis patients selected from a hemodialysis center of Qazvin University of Medical Sciences, Qazvin, Iran. The patients were randomly allocated into two groups (n= 17 patients in each group) in two sequences. In the first sequence, the subjects received four routine hemodialysis sessions in group one and four hemodialysis sessions with the stepwise profile of the fluid flow rate with increased BFR in group two. In the second sequence, the treatment methods were exchanged. Hemodialysis sessions were performed in both sequences, consecutively. Each session was at least three hours. Hemodialysis adequacy was measured using Kt/V software on the hemodialysis machines after each session. Results: The mean score of dialysis adequacy was 0.89 in the routine method and 1.26 in the profile with increased BFR. There was a statistically significant difference between the methods (t= -7.9, df = 33, P < 0.001). Conclusion: The results of the study suggest that the stepwise profile of the dialysis fluid flow rate with increased BFR should be used synchronously to improve hemodialysis adequacy.

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“…From the previous data and results, we recommend that dialysis prescription and modality should be individualized for every patient according to their clinical data and according to the availability of the resources. This individualization may include longer dialysis duration, 26 faster blood flow rates 27 or prolonged dialysis duration, larger‐sized dialyzer, and adding hemofiltration fluid as we did in this study, which were helpful in achieving the recommended targets.…”

Section: Discussionmentioning

confidence: 99%

Improvement of clinical outcomes in dialysis: No convincing superiority in dialysis efficacy using hemodiafiltration vs high‐flux hemodialysis

et al. 2020

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Hemodiafiltration (HDF) is not associated with lower mortality risk compared to standard hemodialysis (HD). However, there are many critical clinical outcomes in dialysis patients in addition to mortality; the impact of HDF on these other outcomes is not clear. This retrospective study included all patients referred to DaVita Clinics in the Kingdom of Saudi Arabia. High‐flux HD was the initial modality in all patients. Those who did not achieve adequacy targets or those with poorly controlled phosphorus were switched to postdilution HDF using 18 to 23 L exchange per treatment. Patients dialyzing with a central venous catheter, patients who dialyzed less than 90 days at DaVita, and those with interrupted HDF were excluded. Of the 1115 patients, 215 (19%) were on HDF and 900 on high‐flux HD; the median follow‐up was 6 months for all patients. The HDF group showed a significant reduction in serum phosphate (P < .001), a significant increase in serum calcium (P < .012) and a significant improvement in Kt/V (P < .0001). The HDF group had significantly higher hemoglobin levels than the HD group (P = .024), with a significant reduction in weekly erythropoiesis‐stimulating agent dose after starting HDF (P < .001). A modified protocol that included prolonged dialysis duration, larger‐sized dialyzer, faster blood flow rates, and adding hemofiltration fluid may be helpful in achieving the recommended targets. Thus, HDF can enable the achievement of adequate dialysis care in some patients. Randomized‐controlled clinical trials are necessary to confirm these findings.

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The impact of blood flow rate during hemodialysis on all-cause mortality

Cited by 26 publications

References 14 publications

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

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

How to increase dialysis adequacy; A randomized clinical trial

Improvement of clinical outcomes in dialysis: No convincing superiority in dialysis efficacy using hemodiafiltration vs high‐flux hemodialysis

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