Department of Internal Medicine, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkiye.
Division of Nephrology, Department of Internal Medicine, Konya City Hospital, Konya, Turkiye.
Turk J Med Sci. 2023 Oct 10;53(6):1863-1869. doi: 10.55730/1300-0144.5756. eCollection 2023.
There are over 60,000 hemodialysis (HD) patients in Türkiye, and the number of patients is increasing yearly. Dialysate flow rate (Qd) is a factor in HD adequacy. Approximately 150 L of water are consumed per session to prepare the dialysate. We aimed to investigate whether HD effectiveness can be achieved at a low Qd in different patient groups for the purpose of saving water.
This prospective study included 81 HD patients from 2 centers. The patients underwent an aggregate total of 486 HD sessions, including 3 sessions at a Qd of 500 mL/min and 3 sessions at a Qd of 300 mL/min for each patient. We used online Kt/V readings recorded at the end of each dialysis session to compare the effectiveness of these 2 types of HD session performed at a different Qd.
The online Kt/V readings were similar between the standard (500) and low (300) Qd HD (1.51 ± 0.41 and 1.49 ± 0.44, respectively, p = 0.069). In the subgroup analyses, men had higher online Kt/V values at the standard Qd compared to the low Qd (1.35 ± 0.30 and 1.30 ± 0.32, respectively, p = 0.019), but the Kt/V values were not different for women. While the low Qd did not reduce online Kt/V in patients using small surface area dialysis membranes (1.75 ± 0.35 for 300 Qd and 1.75 ± 0.32 for 500 Qd, p = 0.931), it was associated with reduced online Kt/V in patients using large surface area dialysis membranes (1.12 ± 0.25 for 300 Qd and 1.17 ± 0.24 for 500 Qd, p = 0.006). The low Qd did not result in differences in online Kt/V among low-weight patients. However, online Kt/V values were better with the standard Qd in patients weighing 65 kg and above.
In our study, dialysis adequacy at a reduced dialysate flow was not inferior for women, patients with low body weight, or patients using small surface area membranes. Individualized HD at a reduced Qd of 300 mL/min in eligible patients can save 48 L of water per HD session and an average of 7500 L of water per year.
土耳其有超过 60000 名血液透析（HD）患者，且患者人数每年都在增加。透析液流量（Qd）是 HD 充分性的一个因素。每次治疗大约需要消耗 150 升水来准备透析液。我们旨在研究在不同患者群体中，低 Qd 是否可以达到 HD 效果，以达到节水的目的。
本前瞻性研究纳入了来自 2 个中心的 81 名 HD 患者。这些患者共接受了 486 次 HD 治疗，其中每位患者各进行了 3 次 Qd 为 500mL/min 的治疗和 3 次 Qd 为 300mL/min 的治疗。我们使用每次透析结束时在线记录的 Kt/V 值来比较这两种不同 Qd 下 HD 治疗的效果。
标准（500）和低（300）Qd HD 的在线 Kt/V 值相似（分别为 1.51±0.41 和 1.49±0.44，p=0.069）。在亚组分析中，男性在标准 Qd 下的在线 Kt/V 值高于低 Qd（分别为 1.35±0.30 和 1.30±0.32，p=0.019），但女性的 Kt/V 值无差异。虽然低 Qd 不会降低使用小表面积透析膜的患者的在线 Kt/V 值（300 Qd 时为 1.75±0.35，500 Qd 时为 1.75±0.32，p=0.931），但它与使用大表面积透析膜的患者的在线 Kt/V 值降低相关（300 Qd 时为 1.12±0.25，500 Qd 时为 1.17±0.24，p=0.006）。低 Qd 不会导致低体重患者的在线 Kt/V 值出现差异。然而，在体重 65kg 及以上的患者中，标准 Qd 的在线 Kt/V 值更好。
在我们的研究中，女性、低体重患者或使用小表面积膜的患者，降低透析液流量并不会降低透析充分性。在符合条件的患者中，个性化的低 Qd（300mL/min）HD 可以节省每次 HD 治疗 48 升水，每年平均节省 7500 升水。
