Abstract: FR-PO0462
Estimated Dialysate and Water Savings in a US Dialysis Clinic Initiating High-Volume Hemodiafiltration
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ficociello, Linda, Renal Research Institute, Waltham, Massachusetts, United States
- Van Zandt, Carly R., Renal Research Institute, Waltham, Massachusetts, United States
- Anger, Michael S., Fresenius Medical Care, Waltham, Massachusetts, United States
- Usvyat, Len A., Renal Research Institute, Waltham, Massachusetts, United States
- Chatoth, Dinesh K., Fresenius Medical Care, Waltham, Massachusetts, United States
- Hippen, Benjamin E., Fresenius Medical Care, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
- Stuard, Stefano, Fresenius Medical Care, Waltham, Massachusetts, United States
Background
Recent analyses have shown online post-dilution high-volume hemodiafiltration (HVHDF) enhances solute clearance and more efficient dialysate utilization compared to hemodialysis (HD). We aimed to estimate dialysate savings from use of high-volume hemodiafiltration (HVHDF) compared to hemodialysis (HD) based on actual dialysis treatments (tx) before and after the introduction of HVHDF in a US clinic.
Methods
The Fresenius Medical Care 5008x Hemodialysis System feature 'Autoflow' automatically adjusts Qd (dialysate flow rate) based on the Qb (blood flow rate) ratio, which can be set at 1.0-1.2. In addition, “AutoSub Plus”, automatically maximizes the substitution rate to try to reach HVHDF. 157 HDF tx were matched by patient to their previous HD tx, before initiating HDF. Dialysate use was estimated from the average Qd delivered and tx time and actual substitution volumes were recorded.
Results
Tx-level, cumulative and estimated parameters per tx are presented (table). Median OLC Kt/V and treatment time were comparable between HD and HDF. Median Qb and Qd were higher in HD (400 ml/min and 800 ml/min) compared to HVHDF (367 ml/min and 446 ml/min). The estimated dialysate used per tx was 156.84 L for HD and 114.05 L for HDF. The average difference per tx was 42.8 L of dialysate. Correcting for substitution volume, we can estimate overall savings as 19.8 L per tx. For a clinic of 100 patients dialyzing thrice weekly, we estimate annual dialysate savings between 308,880 - 667,680 L, depending on substitution volume adjustments.
Conclusion
Compared to conventional HD, HVHDF may enable reduced dialysate consumption without compromising adequacy. Lower Qd, resulting in decreased use of water, acid concentrate, and sodium bicarbonate, and online fluid production, eliminating saline bags, position HVHDF as a more environmentally sustainable dialysis modality in the US.
Funding
- Commercial Support – Fresenius Medical Care