Impact of stepwise sodium and ultra filtration profiles and dialysis solution flow rate profile on dialysis adequacy

BACKGROUND: Inadequate dialysis is one of the main causes of mortality of the patients undergoing hemodialysis. The methods that lead to improvement of dialysis adequacy in these patients are of great importance due to them causing an improvement of quality of life. As numerous factors can play a role in improvement of dialysis adequacy, the present study aimed to investigate the level of impact of stepwise sodium and ultra filtration profiles and dialysis solution flow rate profile on dialysis adequacy. MATERIALS AND METHODS: This is a cross-over clinical trial conducted on 32 patients selected from two hemodialysis centers in Isfahan in 2013. The patients were assigned to two identical groups through random allocation, and each patient in group 1 underwent hemodialysis for four routine dialysis sessions, four stepwise sodium and ultra filtration profile sessions, and four sessions by stepwise dialysis solution flow rate profile. The patients in group 2 underwent hemodialysis for four sessions of stepwise dialysate flow rate profile, four sessions of stepwise sodium and ultra filtration profiles, and four sessions of routine dialysis method. Dialysis adequacy was on line calculated by Kt/V ratio in each session, and was analyzed by repeated measure analysis of variance (ANOVA), least significant difference (LSD) post-hoc test, and independent t-test. RESULTS: Means of dialysis adequacies were 1.239 (0.25) in the routine method, 1.407 (0.26) in stepwise sodium and ultra filtration profiles, and 1.414 (0.26) in dialysis solution flow rate profile. There was a significant difference between the routine method and the other two profiles (P < 0.05), but the difference in dialysis adequacy means in the two profile methods was not significant (P > 0.05). Mean scores of dialysis adequacy in the three treatment methods in the two groups showed that the sequence of methods had no effect on treatment outcome (P > 0.05). CONCLUSIONS: Stepwise sodium and ultra filtration profiles and stepwise dialysis solution flow rate profile are suggested as they can increase dialysis adequacy compared to the routine method.