Abstract: FR-PO1098
Push-Pull-Enhanced Filtration Improves Middle-Molecule Transport Under Low-Dialysate-Flow Conditions
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Yessayan, Lucas, University of Michigan College of Literature Science and the Arts, Ann Arbor, Michigan, United States
- Tolwani, Ashita J., The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Szamosfalvi, Balazs, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
- Yessayan, Lenar Tatios, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
Background
Portable and home hemodialysis systems operate under dialysate-limited conditions with batch dialysate generation, where dialysate flow is lower than blood flow. Strategies that enhance solute transport without increasing dialysate consumption are needed. Push–pull enhanced filtration generates cyclical filtration and backfiltration across the dialyzer membrane and may augment convective transport.
Methods
In vitro experiments compared solute clearance between push–pull enhanced filtration and conventional low dialysate flow hemodialysis under matched conditions. Studies were performed at a blood flow rate of 350 mL/min and flow fractions (FF; defined as the ratio of dialysate flow to blood flow, Qd/Qb) of 0.3, 0.4 and 0.5. Sodium chloride, fluorescein, and FITC-labeled dextrans (4 and 10 kDa) were used to represent a range of solute sizes. Clearance was determined using conductivity- and fluorescence-based assays. Data are presented as mean±SD and compared using two-sided tests, with p<0.05 considered statistically significant.
Results
Clearance of 10 kDa dextran was substantially higher with push–pull enhanced filtration (FF 0.3: 35.5±1.1 vs 24.9±2.1 mL/min; FF 0.5: 34.3±2.7 vs 23.7±1.2 mL/min; p≤0.003). Similar but smaller effects were observed for 4 kDa dextran (FF 0.3: 57.8±2.8 vs 48.8±3.0 mL/min, p=0.019; FF 0.5: 68.3±4.6 vs 58.1±5.3 mL/min, p=0.065). Fluorescein clearance was modestly higher (FF 0.3: 93.2±1.8 vs 86.0±1.9 mL/min; FF 0.5: 129.7±2.3 vs 109.8±8.2 mL/min; p<0.05). In contrast, sodium dialysance was similar between push–pull enhanced filtration and conventional low-flow hemodialysis (FF 0.3: 98.9±2.2 vs 100.7±2.4 mL/min; FF 0.5: 152.2±7.2 vs 153.0±4.8 mL/min; p>0.1).
Conclusion
Under dialysate-limited conditions, push–pull enhanced filtration preserves small-solute clearance while improving middle molecule removal. Modulation of intradialyzer fluid dynamics may enhance solute transport efficiency without increasing dialysate requirements.
Funding
- Commercial Support – This study was supported by i-Dialco, which provided funding for the experimental work.