Utility of a water-sparing approach for reducing dialysate flow rates in hospitalized patients with kidney failure.

Introduction: Hemodialysis (HD) represents a necessary medical intervention for patients with end stage kidney disease (ESKD) with a high carbon footprint that significantly consumes natural resources (i.e. water). Reduction of dialysate flow rate is one strategy that directly targets water waste during HD.

Methods: A retrospective multicenter, observational study was conducted over 12 months in patients with AKI-D and ESKD to evaluate treatments with mid-range dialysate flow rates set at Qd 300 mL/min (Green HD) using the Tablo^® HD System (Outset Medical) versus flow rates ⩾Qd 500 mL/min (Conventional systems).

Results: One thousand one hundred ninety-five treatments were performed in 433 patients using Green HD (Qd = 300 mL/min, n = 575) and Conventional systems (Qd ⩾500 mL/min, n = 620). Mean Qd for Green HD was 300.0 ± 0.0 and mean Qd for the Conventional systems was 686.6 ± 88.3 mL/min. Mean blood flow rates were significantly lower among patients treated with Green HD. Reductions in TACurea and post dialysis serum potassium were similar between the two groups. Estimates for resource utilization were lower using Green HD compared to Conventional systems.

Conclusion: These findings support that higher dialysate flow rates using Conventional systems yield minimal if any benefit in small solute clearance compared to mid-range flow rates. Green HD using the Tablo^® HD System results in comparable benefits in ESKD patients with significant conservation of water resources.