Abstract: FR-PO824
Urea Clearance Modelling Using 300 ml/min of Dialysate Flow
Session Information
- Standard Hemodialysis for ESRD - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 601 Standard Hemodialysis for ESRD
Authors
- Leypoldt, J. Ken, None, Menlo Park, California, United States
- Prichard, Sarah S., Outset Medical, San Jose, California, United States
- Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
- Alvarez, Luis, None, Menlo Park, California, United States
Background
High dialysate flow rates (QD) of 500-700 mL/min are generally used in the outpatient setting to maximize urea removal in a time efficient manner. Lower dialysate flows of 100-200 mL/min are often employed in critically ill patients and in patients at high risk of dialysis disequilibrium. There are few data describing the use of a mid-rate QD (300mL/min) in a modern outpatient dialysis setting. We present urea kinetic modeling of 300 mL/min dialysate flow rates and investigate differential urea clearances between 300 and 500 mL/min QD.
Methods
Urea kinetic models were used to predict urea clearances at 300 mL/min dialysate flows. Using the FHN trial group urea model assumptions in combination with published dialyzer characteristics (KoA), a weekly urea concentration profile was obtained. The model was then applied to patients of different weights and volumes of distribution (VOD) at blood flows (QB) of 400 mL/min. Finally, a clearance relationship for spKt/V of 300 vs. 500 mL/min QD was obtained.
Results
Table 1 shows modelled spKt/V when QD is 300mL/min or 500 mL/min at the same QB of 400 mL/min. Across VOD, the model demonstrates a QD of 300 mL/min results in a predicted spKt/V that meets urea clearance targets. There was a small difference in spKt/V between a QD of 300 mL/min and 500 mL/min QD. Use of a larger KoA (LKoA) dialyzer and 15 minutes of additional time narrows the spKt/V difference.
Conclusion
A QD of 300mL/min can be expected to achieve urea clearance targets. Decreasing dialysate flow rate to 300 mL/min results in a modest, but clinically insignificant, spKt/V difference. For patients with clearance challenges at 500mL/min QD, the use of a 300 mL/min QD with a larger KoA dialyzer and incremental time can be considered, which may itself allow for lower rates of ultrafiltration and better-tolerated hemodialysis therapy.
Table 1: Calculated spKt/V
Dialysate Flow (mL/Min) | 500 | 300 | 300 |
Dialyzer | Standard Dialyzer | Standard Dialyzer | LKoA Dialyzer + 15 min |
VOD=25L, Treatment Time=180 minutes | 1.68* | 1.46 | 1.60 |
VOD=30L, Treatment Time=210 minutes | 1.64 | 1.42 | 1.56 |
VOD=30L, Treatment Time=240 minutes | 1.84 | 1.59 | 1.72 |
VOD=35L, Treatment Time=240 minutes | 1.61 | 1.39 | 1.51 |
*spKt/V
Funding
- Commercial Support –