Slow Extended Nocturnal Home Hemodialysis Shows Superior Adequacy Compared to In-Center Dialysis: A Mathematical Analysis

Abstract

Extended nocturnal home hemodialysis has gained renewed interest. However, no removal data for single/double needle (lumen) (SL and DL, respectively) or for low/high blood flow in extended dialysis are available. Therefore, we studied dialysis adequacy in different nocturnal home hemodialysis strategies. Coupling a kinetic with a dialyzer model, we calculated a reduction ratio from pre- to post-dialysis (RR) and total solute removal (TSR) of urea, methylguanidine (MG), β₂-microglobulin, and phosphate. Simulations were done for dialysis with blood flow Q_b350 ml/min (DL-4h), extended DL high flow with Q_b350 (DL-HF-8h) and low flow with Q_b175 (DL-LF-8h), and SL with Q_b273 (SL-8h). Compared to DL-4h, TSR was 28–59% larger for DL-HF-8h. TSR was most increased for β₂-microglobulin (18%) with DL-LF-8h, and for MG (35%) with SL-8h. Furthermore, RRs were equal (DL-LF-8h), higher (SL-8h), and even more increased (DL-HF-8h) for all studied solutes. In the home setting, DL-LF-8h and SL-8h are safe and promising strategies.

Patient-Centered Home Hemodialysis

“…The advent of nocturnal HD allows for modification in small and middle molecules removal. 42 Musci et al 43 described the doubling of phosphate removal by nocturnal HD. As a result, elimination of phosphate binders and liberalization of diet is achievable.…”

Dr. Sunny Eloot to Serve as a Co‐Editor Representative of the European Society of Artificial Organs

“…Eloot is also visiting professor at Ghent University and the Catholic University of Louvain, both in Belgium, giving guest lectures in the field of artificial organs (i.e., artificial kidney, artificial liver, and vascular access), kinetic modeling, and medical equipment in nephrology and hemodialysis. She has mentored several students and continues to supervise master's and PhD students in engineering as well as in medicine working in the field of dialysis, artificial kidney, and liver. This research is published widely and presented extensively both nationally and internationally.…”