Green Dialysis: Dialysis With Reduced Dialysate Flow
Study Details
Study Description
Brief Summary
Hemodialysis patients consume per year 18.720-26.208L of dialysis fluid (i.e. water). From an ecological point of view, the present study investigated whether reducing this water amount has an impact on the extraction and total solute removal of different uremic toxins. The efficiency of hemodiafiltration with a standard high-flux dialyzer is compared to hemodialysis with a medium cut-off dialyzer with a dialysate flow of either 700mL/min or 300mL/min.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Hemodialysis is currently performed with dialysate flows in the range 500 and 700mL/min respectively in hemodialysis and hemodiafiltration mode. With a standard daytime dialysis scheme of three times four hours a week, each patient consumes up to 360-504L dialysate per week or 18.720-26.208L per year.
From an ecological point of view, one can wonder whether patients can be dialyzed adequately enough using hemodialysis mode with a lower dialysate flow, and as such consuming less water.
Changing the mode from hemodiafiltration to hemodialysis mainly has an impact on the removal of larger toxins which benefit of the convective transport. Lowering dialysate flow in hemodialysis mode mainly has an impact on the removal of small water soluble toxins which are mainly removed by diffusion. For this transport, different parameters are important: blood and dialysate flow, dimensions of the membrane (surface area and thickness), fiber diameter, and extra-luminal space, and membrane porosity (Sieving coefficient). This also implies that, for the same blood and dialysate flow, the choice of the dialyzer will determine toxin transport. The use of a medium cut-off membrane with smaller and more open fibers might thus be more adequate in hemodialysis mode than a standard high-flux dialyzer with wider fibers.
The aim of this study is to quantify instant extraction and overall total solute removal of representative uremic toxins in hemodiafiltration with a standard high-flux hemodialyzer versus hemodialysis with a medium cut-off membrane, either with a standard or reduced dialysate flow.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Hemodiafiltration with high-flux dialyzer Patients are dialysed at midweek using hemodiafiltration (autoflow) with an FX800 Cordiax high-flux dialyzer, with dialysate flow of 700mL/min |
Other: Blood and dialysate sampling
Blood is sampled from the inlet and outlet dialyzer bloodline at 5min after dialysis start.
Spent dialysate is sampled from the outlet dialysate line at 5, 30, 90 and 240min after dialysis start.
Blood and dialysate samples are analysed for different uremic toxins. Dialysis efficiency is calculated from the analysed toxin concentrations.
|
| Experimental: Hemodialysis with medium cut-off dialyzer and high dialysate flow Patients are dialysed at midweek using hemodialysis with a Theranova 400 medium cut-off dialyzer with dialysate flow of 700mL/min |
Other: Blood and dialysate sampling
Blood is sampled from the inlet and outlet dialyzer bloodline at 5min after dialysis start.
Spent dialysate is sampled from the outlet dialysate line at 5, 30, 90 and 240min after dialysis start.
Blood and dialysate samples are analysed for different uremic toxins. Dialysis efficiency is calculated from the analysed toxin concentrations.
|
| Experimental: Hemodialysis with medium cut-off dialyzer and low dialysate flow Patients are dialysed at midweek using hemodialysis with a Theranova 400 medium cut-off dialyzer with dialysate flow of 300mL/min |
Other: Blood and dialysate sampling
Blood is sampled from the inlet and outlet dialyzer bloodline at 5min after dialysis start.
Spent dialysate is sampled from the outlet dialysate line at 5, 30, 90 and 240min after dialysis start.
Blood and dialysate samples are analysed for different uremic toxins. Dialysis efficiency is calculated from the analysed toxin concentrations.
|
Outcome Measures
Primary Outcome Measures
- Dialysis efficiency [three midweek dialysis sessions (3 arms)]
Dialyzer extraction and total solute removal are measured and calculated for different uremic toxins
Eligibility Criteria
Criteria
Inclusion Criteria:
-
stable chronic hemodialysis patient
-
well functioning vascular access
Exclusion Criteria:
-
active infection
-
malignancies
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Ghent University Hospital | Gent | Belgium | 9000 |
Sponsors and Collaborators
- University Hospital, Ghent
Investigators
- Principal Investigator: Van Biesen, PhD, University Hospital, Ghent
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- ONZ-2023-0170