Blood purification · 2025
Effect of Reduced Dialysate Flow on Dialysis Adequacy: A Pilot Study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Belmouaz Mohamed, Dibon Charles, Devaux Jean-Philippe, Duthe Fabien, Wong-Cheng Romain, Lemarchand Clemence, Ecotiere Laure, Gombert Jean-Marc, Jacomet Florence, Ayraud-Thevenot Sarah, Durocher Lisa, Thierry Antoine, Saulnier Pierre-Jean, Bridoux Frank
Аннотация
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.
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.