Abstract: FR-PO479
Controlling High Pre-Dialysis Serum Total Carbon Dioxide Concentration with Low Dialysate Flow Systems During Frequent Nocturnal Hemodialysis
Session Information
- Hemodialysis and Frequent Dialysis - IV
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Leypoldt, J. Ken, Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
- Kraus, Michael A., NxStage Medical, Inc, Fishers, Indiana, United States
- Collins, Allan J., NxStage Medical, Inc., Lawrence, Massachusetts, United States
Background
Although use of low dialysate bicarbonate concentration ([bicarbonate]) during in-center, thrice weekly in-center hemodialysis (ICHD) is a common strategy to control high serum predialysis serum total carbon dioxide concentration ([TCO2]), such an approach is not always possible with commercial lactate dialysates. We used clinical data in patients who transferred from ICHD using bicarbonate dialysate to 6 times per week hemodialysis during the FREEDOM Study and the H+ mobilization model (Sargent et al, Semin Dial 31:468-78, 2018) to calculate the effect of using 30 L versus 60 L of dialysate volume per treatment to reduce [TCO2] during frequent nocturnal hemodialysis (NHD).
Methods
The H+ mobilization model was first used to simulate ICHD treatments using dialysate [bicarbonate] of 34, 37 & 40 mEq/L at [TCO2] of 22, 24 & 26 mEq/L to calculate a weekly acid generation rate. Assuming a constant weekly acid generation rate, patients were assumed transferred to NHD with treatment (Tx) frequencies of 3.5 (every other day), 4 & 5 times per week and dialysate volumes per Tx of 30 L & 60 L. Blood flow rate was assumed as 300 mL/min, Tx time of 420 min, and dialysate [lactate] was 40 mEq/L during NHD.
Results
Summary results are tabulated. Lowering dialysate volume per Tx from 60 to 30 L resulted in lower [TCO2] by approximately 2-3 mEq/L.
Conclusion
Patients who may achieve excessively high [TCO2] during NHD using lactate as dialysate buffer can use of 30 L instead of 60 L per treatment to reduce [TCO2]. Such reductions in dialysate volume during NHD are not expected to substantially lower dialysis adequacy.
[TCO2] During NHD (mEq/L)
| 3.5 Tx/wk | 4 Tx/wk | 5 Tx/wk | ||||
| [TCO2] during ICHD | DV=30 L | DV=60 L | DV=30 L | DV=60 L | DV=30 L | DV=60 L |
| 22 | 20 | 23 | 21 | 24 | 24 | 26 |
| 24 | 21 | 24 | 23 | 25 | 25 | 27 |
| 26 | 23 | 26 | 25 | 27 | 27 | 28 |
All values averaged during ICHD treatments (Tx) using dialysate [bicarbonate] of 34, 37 & 40 mEq/L; the standard deviation of all values was 1 mEq/L. (DV denotes dialysate volume per treatment.)
Funding
- Commercial Support –