Effect of Reduced Dialysate Flow on Dialysis Adequacy: A Pilot Study.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2026-01-01 Epub Date: 2025-10-21 DOI:10.1159/000549110

Mohamed Belmouaz, Charles Dibon, Jean-Philippe Devaux, Fabien Duthe, Romain Wong-Cheng, Clemence Lemarchand, Laure Ecotiere, Jean-Marc Gombert, Florence Jacomet, Sarah Ayraud-Thevenot, Lisa Durocher, Antoine Thierry, Pierre-Jean Saulnier, Frank Bridoux

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引用次数: 0

Abstract

Introduction: The standard dialysate flow (Qd) for hemodialysis (HD) is currently set at 500 mL/min. One potential, sustainable, and cost-effective solution for eco-friendly HD may involve reducing Qd to limit wastewater. However, the effect of reduced Qd on small molecule and middle molecule (MM) removal remains to be investigated.

Methods: In this prospective observational study, 74 patients on different maintenance dialysis modalities with Qd set at 500 mL/min (Qd500) were assigned to receive Qd at 400 mL/min (Qd400) for 3 months. Dialysis adequacy, including small solute removal and MM reduction ratio (RR), was evaluated at enrollment and after 3 months.

Results: Compared to Qd500, Qd400 after 3 months achieved similar single-pool Kt/V (1.41 ± 0.30 vs. 1.43 ± 0.33, p = 0.58), equilibrated KT/V, urea RR, creatinine RR, and phosphate RR. Qd400 vs. Qd500 provided significantly higher beta2-microglobulin RR (77.0 [71.4-81.7] vs. 74.7 [68.4-79.4] %, p = 0.009) and lower kappa free light chain (FLC) RR (54.2 [42.1-64.4] vs. 57.6 [41.6-65.0] %, p = 0.03), whereas myoglobin and lambda FLC RR were similar. Qd400 resulted in higher pre-dialysis urea (20.2 ± 5.5 vs. 18.2 ± 6.2 mmol/L, p = 0.002), creatinine (694.0 ± 179.5 vs. 665.6 ± 220.4 µmol/L, p = 0.029), beta2-microglobulin (26.5 [23.0-30.0] vs. 23.5 [20.0-28.0] mg/L, p = 0.0001), and myoglobin (174.0 [122.0-251.0] vs. 159.5 [119.0-195.0] µg/L, p = 0.033) levels. Pre-dialysis levels of albumin, potassium, bicarbonate, phosphate, and calcium were similar between Qd400 and Qd500.

Conclusion: Three months of Qd at 400 mL/min appears to provide similar small molecule and MM removal, but with an increase in pre-dialysis urea, creatinine, beta2-microglobulin, and myoglobin levels. Although this strategy could help preserve water, its potential impact on long-term clinical outcomes deserves further evaluation.

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减少透析液流量对透析充分性的影响：一项初步研究。

血液透析（HD）的标准透析液流量（Qd）目前设定为500 mL/min。环保HD的一个潜在、可持续和具有成本效益的解决方案可能涉及减少Qd以限制水浪费。然而，减少量子点对小分子和中分子（MM）去除的影响仍有待研究。在这项前瞻性观察研究中，74名采用不同维持性透析方式，Qd设定为500 mL/min （Qd500）的患者被分配接受Qd400 mL/min (Qd400)，为期3个月。透析充分性包括小溶质去除和MM减少率（RR）在入组时和3个月后进行评估。与Qd500相比，Qd400在3个月后获得相似的spKt/V（1.41±0.30 vs 1.43±0.33,p=0.58）、eKt/V、尿素RR、肌酐RR和磷酸盐RR。与Qd500相比，Qd400提供了更高的β -微球蛋白RR[77.0（71.4-81.7）比74.7 (68.4-79.4)%,p=0.009]和更低的kappa FLC RR[54.2（42.1-64.4）比57.6 (41.6-65.0)%,p=0.03]，而肌红蛋白和lambda FLC RR相似。Qd400导致透析前尿素（20.2±5.5 vs 18.2±6.2 mmol/L, p=0.002）、肌酐（694.0±179.5 vs 665.6±220.4µmol/L, p=0.029）、β -微球蛋白[26.5 (23.0-30.0)vs 23.5 (20.0-28.0) mg/L, p=0.0001]和肌红蛋白[174.0 (122.0-251.0)vs 159.5（119.0-195.0）µg/ L, p=0.033]水平升高。透析前白蛋白、钾、碳酸氢盐、磷酸盐和钙水平在Qd400和Qd500之间相似。以400ml /min的Qd治疗3个月，似乎可以提供类似的小和MM的去除，但透析前尿素、肌酐、β -微球蛋白和肌红蛋白水平增加。尽管这一策略有助于保护水资源，但其对长期临床结果的潜在影响值得进一步评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

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.