Thomas Golper
Last active: 4/25/2016

Dialysate flow rate and delivered Kt/Vurea for dialyzers with enhanced dialysate flow distribution.

Ward RA, Idoux JW, Hamdan H, Ouseph R, Depner TA, Golper TA
Clin J Am Soc Nephrol. 2011 6 (9): 2235-9

PMID: 21799145 · PMCID: PMC3358998 · DOI:10.2215/CJN.02630311

BACKGROUND AND OBJECTIVES - Previous in vitro and clinical studies showed that the urea mass transfer-area coefficient (K(o)A) increased with increasing dialysate flow rate. This observation led to increased dialysate flow rates in an attempt to maximize the delivered dose of dialysis (Kt/V(urea)). Recently, we showed that urea K(o)A was independent of dialysate flow rate in the range 500 to 800 ml/min for dialyzers incorporating features to enhance dialysate flow distribution, suggesting that increasing the dialysate flow rate with such dialyzers would not significantly increase delivered Kt/V(urea).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - We performed a multi-center randomized clinical trial to compare delivered Kt/V(urea) at dialysate flow rates of 600 and 800 ml/min in 42 patients. All other aspects of the dialysis prescription, including treatment time, blood flow rate, and dialyzer, were kept constant for a given patient. Delivered single-pool and equilibrated Kt/V(urea) were calculated from pre- and postdialysis plasma urea concentrations, and ionic Kt/V was determined from serial measurements of ionic dialysance made throughout each treatment.

RESULTS - Delivered Kt/V(urea) differed between centers; however, the difference in Kt/V(urea) between dialysate flow rates of 800 and 600 ml/min was NS by any measure (95% confidence intervals of -0.064 to 0.024 for single-pool Kt/V(urea), -0.051 to 0.023 for equilibrated Kt/V(urea), and -0.029 to 0.099 for ionic Kt/V).

CONCLUSIONS - These data suggest that increasing the dialysate flow rate beyond 600 ml/min for these dialyzers offers no benefit in terms of delivered Kt/V(urea).

MeSH Terms (11)

Adult Aged Aged, 80 and over Cross-Over Studies Dialysis Solutions Female Humans Male Middle Aged Renal Dialysis Urea

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