The impact of blood flow rate on dialysis dose and phosphate removal in hemodialysis patients

Abstract

The inadequacy of dialysis and hyperphosphatemia are both associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. The aim of this study was to determine the effect of increasing BFR on dialysis dose and phosphate removal. Forty-four patients were included in a cross-sectional study. Each patient received six consecutive dialysis sessions as follows: three consecutive sessions with a BFR of 250 mL/min, followed by three others with BFR of 350 mL/min without changing the other dialysis parameters. Patients' body weight was recorded, and blood samples (serum urea and phosphate) were collected before and after each dialysis session. For assessing the efficacy of dialysis, urea reduction ratio (URR), Kt/VDiascan (Kt by Diascan and V by Watson), Kt/V Daugirdas (Daugirdas 2 generation), equilibrated Kt/V, and phosphate reduction rate (PRR) were used. The increase of BFR by 100 mL/min resulted in a significant increase of URR, Kt/V , Kt/V, equilibrated Kt/V, and PRR: URR; 75.41 ± 5.60; 83.51 ± 6.12; P <0.001), (Kt/V; 1.28 ± 0.25; 1.55 ± 0.15; P <0.001), (Kt/V; 1.55 ± 0.26; 2.10 ± 0.61; P = 0.001), equilibrated Kt/V; 1.40 ± 0.19; 1.91 ± 0.52; P = 0.001), and (PRR; 50.32 ± 12.22; 63.66 ± 13.10; P = 0.010). Adequate dialysis, defined by single-pool Kt/V ≥1.4, was achieved using two different BFRs: 250 and 350 mL/min, respectively, in 73% and 100% of the cases. Increasing the BFR by 40% is effective in increasing dialysis dose and phosphate reduction rate during high-flux HD. The future prospective studies are needed to evaluate the impact of increasing BFR on phosphate removal using the total amount of phosphate removed, and also evaluate the cardiovascular outcome of phosphate reduction and dialysis improvement.

EOS789, a broad-spectrum inhibitor of phosphate transport, is safe with an indication of efficacy in a phase 1b randomized crossover trial in hemodialysis patients

“…Wang et al demonstrated that anuric patients undergoing peritoneal dialysis had elevated serum P levels nearly twice as often as patients without residual renal function 28 . The removal of P with dialysis varies considerably and is affected by blood flow, dialysis duration, the predialysis serum P, PTH level and ultrafiltration volume 29,30 . Traditional thrice weekly hemodialysis leads to a rebound of serum P from extracellular stores, including bone, after dialysis but the timing of that rebound varies [31][32][33] .…”

Effect of Venoplasty on Arteriovenous Fistula Dysfunction on Quick of Blood Values of Hemodialysis Patients

“…The European Best Practice Guidelines, Kidney Disease Outcomes Quality Initiative (KDOQI) and the Indonesian Nephrology Association (PERNEFRI) recommend a URR of at least 65%. 6,8,9 In patients with end stage renal disease (ESRD), AVF is the preferred access to HD, but often complicated by stenosis. Stenosis in AVF dysfunction can be managed with endovascular procedures such as percutaneous balloon venoplasty.…”