Abstract: TH-PO0856
Lower Dialysate Flow Rates: A Simple Change with Scalable Effect
Session Information
- Dialysis: Prescription, Physiology, and Treatment Optimization
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Weber, Catherine L., McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
- Tom, Alexander, McGill University Health Centre, Montreal, Quebec, Canada
- Lucena, Rui, Fresenius Medical Care AG, Bad Homburg, HE, Germany
Background
A 2026 United Nations report declared the world has entered an era of global water bankruptcy. Environmental sustainability in nephrology is an urgent priority, and modest operational changes such as reducing dialysate flow rate (DFR) can have substantial environmental impact at scale. Although the prevalence of prescriptions using a DFR of 800 mL/min is unknown, evidence shows minimal incremental clearance benefit from this legacy practice.
Methods
Using publicly available data, we constructed a modeling analysis to estimate water utilization and costs associated with alternative DFR strategies amongst prevalent U.S. adults (>18 years) receiving facility hemodialysis. State-level water cost estimates were used as a comparative proxy. Treatment level water volumes were calculated assuming a session duration of 218 minutes, blood flow rate of 402 mL/min, and 67% total water discharged to drain, unless otherwise specified. Facility level impact was modelled in states representing extreme, high, and moderate water stress.
Results
In 2022, 473,577 U.S. patients received facility based dialysis (USRDS). Reducing DFR from 800 to 500 mL/min saves an estimated 4.8 billion liters of water and $7.9 million annually; when water treatment system (WTS) inefficiencies are included, savings increase to 14.7 billion liters and $24.0 million. These savings persist even with extension of treatment time to 240 minutes. Combining DFR reduction with an efficient WTS (30% water discharged to drain) results in 27.6 billion liters of water saved and $45.1 million in annual cost avoidance. The greatest modeled benefit was observed with conversion from conventional hemodialysis with DFR 800 mL/min to high volume hemodiafiltration (Qd/Qb 1.2, 25L substitution), yielding 30.6 billion liters of water savings and $50.1 million annually under efficient WTS conditions. Our model demonstrates the impact of how drought and poor water quality increases water utilization on hemodialysis. Facility level cost savings vary by degree of water stress.
Conclusion
Water scarcity is increasing across the United States while environmental, social, and governance expectations in healthcare continue to rise. Water conservation strategies such as reducing DFR, improving WTS efficiency, and adopting new technologies are not only environmentally responsible but also financially and strategically sound investments for dialysis providers.