Abstract: TH-PO289
Impact of Dialysate Flow Rates on Dialysis Adequacy: A Systematic Review and Meta-Analysis
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Iman, Yasmin A., Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Komenda, Paul, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Hovhannisyan, Karen, Quanta Dialysis Technologies Ltd, Alcester, Warwickshire, United Kingdom
- Ewhrudjakpor, Ruth, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Gorbe, Kelley Lee, Quanta Dialysis Technologies Ltd, Alcester, Warwickshire, United Kingdom
- Bamforth, Ryan J., Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Whitlock, Reid, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Collister, David Thomas, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Background
Patients with kidney failure on hemodialysis (HD) require adequate removal of uremic solutes and fluid. Historically, dialysis adequacy is measured by multiplying dialyzer clearance of urea (K) by duration of dialysis session (t) adjusted for patient volume of distribution (V). There are many ways of improving dialysis adequacy, including, increasing dialysis time and frequency, maximizing blood flow rates, and using higher surface area dialyzers. However, the relative impact of dialysate flow rates on dialysis adequacy is poorly described. This systematic review and meta-analysis examines the impact of dialysate flow rates on dialysis adequacy.
Methods
We searched EMBASE, MEDLINE, and the Cochrane Library from inception until April 2022 for randomized controlled trials of any design and observational studies comparing higher dialysate flow rates (>500mL/min) and lower dialysate flow rates (<500mL/min) vs. a standard dialysate flow rate (500 mL/min) in adults (age ≥18 years) treated with chronic HD (>90 consecutive days) for the outcome of dialysis adequacy, measured by Kt/V. We used random effects meta-analysis to estimate pooled mean difference in Kt/V at fixed dialysis durations, blood flows and dialyzers.
Results
A total of 3118 studies were identified in the literature search. Of those, 11 met eligibility criteria and were included for analysis. In the 10 comparisons (n = 732) of a higher dialysate flow rate (560-800 mL/min) vs. a dialysate flow rate of 500 mL/min, a higher dialysate flow rate was associated with an increase in single pooled Kt/V (spKt/V) of 0.12 (95% CI: 0.06–0.18). In the 2 comparisons (n = 24) of a dialysate flow rate of 500 mL/min vs. a lower dialysate flow rate of 300 mL/min, a dialysate flow rate of 500 mL/min showed an increase in spKt/V (mean difference = 0.16) but limited data precluded a meta-analysis.
Conclusion
In our systematic review and meta-analysis, we found a higher dialysate flow rate is associated with an improvement in dialysis adequacy compared with a standard dialysate flow rate. More studies are needed to compare a dialysate flow rate of 500 mL/min vs. a dialysate flow rate of 300 mL/min as some self-care HD systems are unable to attain dialysate flow rates >500 mL/min due to the use of batch-based dialysate or limitations of water systems.
Funding
- Commercial Support –