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Is it useful to increase dialysate flow rate to improve the delivered Kt?

BACKGROUND: Increasing dialysate flow rates (Qd) from 500 to 800 ml/min has been recommended to increase dialysis efficiency. A few publications show that increasing Qd no longer led to an increase in mass transfer area coefficient (KoA) or Kt/V measurement. Our objectives were: 1) Studying the effe...

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Autores principales: Albalate, Marta, Pérez-García, Rafael, de Sequera, Patricia, Corchete, Elena, Alcazar, Roberto, Ortega, Mayra, Puerta, Marta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369100/
https://www.ncbi.nlm.nih.gov/pubmed/25884763
http://dx.doi.org/10.1186/s12882-015-0013-9
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author Albalate, Marta
Pérez-García, Rafael
de Sequera, Patricia
Corchete, Elena
Alcazar, Roberto
Ortega, Mayra
Puerta, Marta
author_facet Albalate, Marta
Pérez-García, Rafael
de Sequera, Patricia
Corchete, Elena
Alcazar, Roberto
Ortega, Mayra
Puerta, Marta
author_sort Albalate, Marta
collection PubMed
description BACKGROUND: Increasing dialysate flow rates (Qd) from 500 to 800 ml/min has been recommended to increase dialysis efficiency. A few publications show that increasing Qd no longer led to an increase in mass transfer area coefficient (KoA) or Kt/V measurement. Our objectives were: 1) Studying the effect in Kt of using a Qd of 400, 500, 700 ml/min and autoflow (AF) with different modern dialysers. 2) Comparing the effect on Kt of water consumption vs. dialysis time to obtain an individual objective of Kt (Ktobj) adjusted to body surface. METHODS: This is a prospective single-centre study with crossover design. Thirty-one patients were studied and six sessions with each Qd were performed. HD parameters were acquired directly from the monitor display: effective blood flow rate (Qbe), Qd, effective dialysis time (Te) and measured by conductivity monitoring, final Kt. RESULTS: We studied a total of 637 sessions: 178 with 500 ml/min, 173 with 700 ml/min, 160 with AF and 126 with 400 ml/min. Kt rose a 4% comparing 400 with 500 ml/min, and 3% comparing 500 with 700 ml/min. Ktobj was reached in 82.4, 88.2, 88.2 and 94.1% of patients with 400, AF, 500 and 700 ml/min, respectively. We did not find statistical differences between dialysers. The difference between programmed time and Te was 8′ when Qd was 400 and 500 ml/min and 8.8′ with Qd = 700 ml/min. Calculating an average time loss of eight minutes/session, we can say that a patient loses 24′ weekly, 312′ monthly and 62.4 hours yearly. Identical Kt could be obtained with Qd of 400 and 500 ml/min, increasing dialysis time 9.1′ and saving 20% of dialysate. CONCLUSIONS: Our data suggest that increasing Qd over 400 ml/min for these dialysers offers a limited benefit. Increasing time is a better alternative with demonstrated benefits to the patient and also less water consumption. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-015-0013-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-43691002015-03-22 Is it useful to increase dialysate flow rate to improve the delivered Kt? Albalate, Marta Pérez-García, Rafael de Sequera, Patricia Corchete, Elena Alcazar, Roberto Ortega, Mayra Puerta, Marta BMC Nephrol Research Article BACKGROUND: Increasing dialysate flow rates (Qd) from 500 to 800 ml/min has been recommended to increase dialysis efficiency. A few publications show that increasing Qd no longer led to an increase in mass transfer area coefficient (KoA) or Kt/V measurement. Our objectives were: 1) Studying the effect in Kt of using a Qd of 400, 500, 700 ml/min and autoflow (AF) with different modern dialysers. 2) Comparing the effect on Kt of water consumption vs. dialysis time to obtain an individual objective of Kt (Ktobj) adjusted to body surface. METHODS: This is a prospective single-centre study with crossover design. Thirty-one patients were studied and six sessions with each Qd were performed. HD parameters were acquired directly from the monitor display: effective blood flow rate (Qbe), Qd, effective dialysis time (Te) and measured by conductivity monitoring, final Kt. RESULTS: We studied a total of 637 sessions: 178 with 500 ml/min, 173 with 700 ml/min, 160 with AF and 126 with 400 ml/min. Kt rose a 4% comparing 400 with 500 ml/min, and 3% comparing 500 with 700 ml/min. Ktobj was reached in 82.4, 88.2, 88.2 and 94.1% of patients with 400, AF, 500 and 700 ml/min, respectively. We did not find statistical differences between dialysers. The difference between programmed time and Te was 8′ when Qd was 400 and 500 ml/min and 8.8′ with Qd = 700 ml/min. Calculating an average time loss of eight minutes/session, we can say that a patient loses 24′ weekly, 312′ monthly and 62.4 hours yearly. Identical Kt could be obtained with Qd of 400 and 500 ml/min, increasing dialysis time 9.1′ and saving 20% of dialysate. CONCLUSIONS: Our data suggest that increasing Qd over 400 ml/min for these dialysers offers a limited benefit. Increasing time is a better alternative with demonstrated benefits to the patient and also less water consumption. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-015-0013-9) contains supplementary material, which is available to authorized users. BioMed Central 2015-02-14 /pmc/articles/PMC4369100/ /pubmed/25884763 http://dx.doi.org/10.1186/s12882-015-0013-9 Text en © Albalate et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Albalate, Marta
Pérez-García, Rafael
de Sequera, Patricia
Corchete, Elena
Alcazar, Roberto
Ortega, Mayra
Puerta, Marta
Is it useful to increase dialysate flow rate to improve the delivered Kt?
title Is it useful to increase dialysate flow rate to improve the delivered Kt?
title_full Is it useful to increase dialysate flow rate to improve the delivered Kt?
title_fullStr Is it useful to increase dialysate flow rate to improve the delivered Kt?
title_full_unstemmed Is it useful to increase dialysate flow rate to improve the delivered Kt?
title_short Is it useful to increase dialysate flow rate to improve the delivered Kt?
title_sort is it useful to increase dialysate flow rate to improve the delivered kt?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369100/
https://www.ncbi.nlm.nih.gov/pubmed/25884763
http://dx.doi.org/10.1186/s12882-015-0013-9
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