Maryn Gardner, Nicole E Wyatt, Neil Sanghani, Ahmed Attia, Andrew Guide, Robert A Greevy, Megha Salani, Osama El Shamy
{"title":"Effect of Lowering Dialysate Flow Rate on Dialysis Dose and Laboratory Values.","authors":"Maryn Gardner, Nicole E Wyatt, Neil Sanghani, Ahmed Attia, Andrew Guide, Robert A Greevy, Megha Salani, Osama El Shamy","doi":"10.1159/000545898","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The rationale behind using higher dialysate flow rates stems from the idea of maximizing a dialysis membrane's extraction ratio. Subsequent developments in dialysis membrane design, including the hollow fiber undulations, spacer yarns, and altering the fiber packing density helped reduce blood and dialysate flow mismatch in dialysis membranes.</p><p><strong>Methods: </strong>Single-center retrospective analysis of in-center dialysis patients. Adult (age ≥18 years) in-center hemodialysis patients who were receiving dialysis at the centers 3 months prior to and 3 months following the change in dialysate flow rates were included in the study (December 2022 to May 2023). Dialysate flow rates were reduced from 800 to 600ml/min - using the same access and dialysis membrane.</p><p><strong>Results: </strong>68 patients were enrolled in the study. The change of dialysate flow rate did not result in a statistically significant change in dialysis adequacy (Kt/Vurea). All regression coefficients were below 0.05 (i.e. a 0.05 change in dialysis adequacy for flow rate 600 vs 800ml/min). Significant associations were found between dialysis adequacy and both the blood flow rate and dialysate sodium, but these were also clinically negligible differences. Analysis of patients' laboratory testing showed no statistically significant difference in serum electrolyte values (sodium, potassium, bicarbonate, blood urea nitrogen and creatinine) Conclusion: In patients treated using the same dialysate filter and dialysis access, changing the dialysate flow rate from 800 to 600ml/min does not result in clinically significant changes in either patients' measured serum electrolytes or dialysis adequacy.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":2.2000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000545898","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The rationale behind using higher dialysate flow rates stems from the idea of maximizing a dialysis membrane's extraction ratio. Subsequent developments in dialysis membrane design, including the hollow fiber undulations, spacer yarns, and altering the fiber packing density helped reduce blood and dialysate flow mismatch in dialysis membranes.
Methods: Single-center retrospective analysis of in-center dialysis patients. Adult (age ≥18 years) in-center hemodialysis patients who were receiving dialysis at the centers 3 months prior to and 3 months following the change in dialysate flow rates were included in the study (December 2022 to May 2023). Dialysate flow rates were reduced from 800 to 600ml/min - using the same access and dialysis membrane.
Results: 68 patients were enrolled in the study. The change of dialysate flow rate did not result in a statistically significant change in dialysis adequacy (Kt/Vurea). All regression coefficients were below 0.05 (i.e. a 0.05 change in dialysis adequacy for flow rate 600 vs 800ml/min). Significant associations were found between dialysis adequacy and both the blood flow rate and dialysate sodium, but these were also clinically negligible differences. Analysis of patients' laboratory testing showed no statistically significant difference in serum electrolyte values (sodium, potassium, bicarbonate, blood urea nitrogen and creatinine) Conclusion: In patients treated using the same dialysate filter and dialysis access, changing the dialysate flow rate from 800 to 600ml/min does not result in clinically significant changes in either patients' measured serum electrolytes or dialysis adequacy.
背景：使用更高的透析液流速背后的基本原理源于最大化透析膜提取率的想法。透析膜设计的后续发展，包括中空纤维波动、间隔纱和改变纤维堆积密度，有助于减少透析膜中血液和透析液流动的不匹配。方法：对中心透析患者进行单中心回顾性分析。在透析液流速改变前3个月和改变后3个月在中心接受透析的成人（年龄≥18岁）血液透析患者被纳入研究（2022年12月至2023年5月）。透析液流速从800毫升/分钟减少到600ml/分钟-使用相同的通道和透析膜。结果：68例患者入组。透析液流速的改变没有导致透析充分性（Kt/ v尿素）的统计学显著变化。所有回归系数均低于0.05（即，当流速600 vs 800ml/min时，透析充分性变化0.05）。发现透析充分性与血流量和透析液钠之间存在显著关联，但这些差异在临床上也可以忽略不计。分析患者实验室检测结果，血清电解质值（钠、钾、碳酸氢盐、血尿素氮和肌酐）差异无统计学意义。结论：在使用相同透析滤器和透析通路的患者中，将透析液流量从800 ml/min改变为600ml/min不会导致患者血清电解质测量值或透析充分性的临床显著变化。
期刊介绍：
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
