Kidney Week

Abstract: FR-PO1013

Novel Sequential Blood Flow Rate Hemodialysis Prescription

Session Information

• Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Author

• Mars, Ronald L., University of Florida, Jacksonville, Florida, United States

Ronald L. Mars, MD, FASN

Introduction

We report a case of severe hyperkalemia and azotemia in a patient with severe renal failure treated with sequential blood flow rates to improve life-threatening hyperkalemia while avoiding DDS.

Case Description

A 52-year-old 73-Kg female with no prior history of chronic kidney disease (CKD) presented with 2-week history of dyspnea, melena, oliguria, and anorexia after 2-month history of daily use of ibuprofen. Laboratory data confirmed BUN 113 mg/dl, creatinine 16.5 mg/dl, potassium [K] 8.7 mEq/L and eGFR 2 ml/min. Chest x-ray showed pulmonary edema; ECG was normal. Emergency dialysis was prescribed utilizing sequential blood flow rates (BFR) with first hour at 225 ml/min followed by second hour 250 ml/min. Dialysate flow rate (DFR) was constant at 500 ml/min with a 2 mEq/L [K] bath. A standard Fresenius Optiflux F180NR dialysis filter and continuous ECG monitoring were used. After dialysis treatment, urea reduction ratio (URR) was 46% with BUN of 61.0 mg/dl while [K] decreased by 41% to 5.1 mEq/L. Post dialysis the patient showed no signs of dialysis disequilibrium syndrome (DDS),

Literature review is vague on methods to initiate 1^st time hemodialysis (HD). Factors to consider include rate of urea reduction, effect of changing [K] on myocardial excitability, and length of time to allow for adequate ultrafiltration (UF) without risking DDS or hypotension. This case report is one of several included in a pilot study of sequential BFR (225, 250, 275 cc/min) to address the parameters that a 1^st time prescription must include to limit a URR to 35-45% & development of DDS, allow sufficient UF (13 cc/kg/hour) without exceeding safe hemodynamic outcomes, improve [K] while getting continuous telemetry monitoring, and to improve uremic symptoms. The second next day HD follows a similar format but allows for increased sequential BFR’s (250, 275, 300 cc/mi) while the 3^rd HD allows BFR’s 300, 325, 350 cc/min.

Discussion

Patients who develop chronic kidney disease (CKD) unknowingly place enormous demands on physiological mechanisms that over time compensate for uremic symptoms and volume overload. Providing safe HD can be an art in creatively adopting a sensible prescription that addresses those parameters that affect patient safety during HD. We believe that our pilot study of sequential BFR’s and variable times for UF is a prescription that fulfills standards of care without jeopardizing patient safety.