Abstract: SA-PO425
Reductions in Dialysate Flow Rates Among a Large Cohort of Hemodialysis (HD) Patients and Impacts on Dialysis Adequacy
Session Information
- Hemodialysis and Frequent Dialysis: Clearance, Technology, Infection
November 05, 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
- Ficociello, Linda, Fresenius Medical Care, Waltham, Massachusetts, United States
- Rogers, Brooks E., Fresenius Medical Care, Waltham, Massachusetts, United States
- Stennett, Amanda, Fresenius Medical Care, Waltham, Massachusetts, United States
- Goldberg, Marcy Eber, Fresenius Medical Care, Waltham, Massachusetts, United States
- Smith, Paul, Fresenius Medical Care, Waltham, Massachusetts, United States
- Belmonte, Kathleen, Fresenius Medical Care, Waltham, Massachusetts, United States
- Hymes, Jeffrey L., Fresenius Medical Care, Waltham, Massachusetts, United States
Background
National shortages of dialysate have led to measures to optimize therapy while conserving dialysate in US dialysis clinics. Dialysis adequacy >1.2 is a major indicator of therapy achievement. The current analysis aimed to assess whether lowering of dialysate flow (Qd) to 500 ml/min was accompanied by changes in dialysis adequacy or changes in other HD prescription parameters.
Methods
Included in the analysis were Fresenius Kidney Care HD patients dialyzed 1/21/22-1/22/22 and had their Qd set to 500 ml/min at the discretion of the treating physician by 2/25/22-2/26/22. Approximately 30% of patients were not included because their Qd remained >500 ml/min. Patients were categorized into the following categories based on dialysis adequacy (based on dialysis machine online clearance): <1.2, 1.2-1.4, >1.4. Changes in delivered treatment parameters were counted, including changing treatment time ≥10 minutes, blood flow (Qb) by ≥25 ml/min, or dialyzer size.
Results
Patients (n=92,768) were, on average, aged 64 years with 4.5 years dialysis vintage and 43% were women. On average patients’ Qd was lowered from 687 to 500 ml/min. As shown in Figure, 76% of patients remained in their adequacy category despite reducing Qd to 500 ml/min, while 13% and 11% decreased or increased adequacy category, respectively. For those remaining in the same category, the majority achieve this without changes to dialysis prescriptions (64%) where 20% increased time, Qb, or dialyzer size. Among the patients who lowered adequacy, 91% had treatment parameters stay the same or decrease.
Conclusion
Reductions in Qd to 500 ml/min were not accompanied by decreases in dialysis adequacy in 87% of patients. In the 13% of patients with decreases, no increases in HD prescriptions were observed for 91% of patients. An algorithm outlining steps to adjust HD prescriptions when it is necessary to lower Qd may need to be developed as part of preparedness plans.
Funding
- Commercial Support –