The Effect of Increasing Surface Area of Dialyzer Membrane on Adequacy of Hemodialysis

Introduction: The patients with end stage renal disease requires 12 hours of hemodialysis per week divided in three equal sessions (4 hours/day for 3 days/week). Some studies show that adequacy of hemodialysis can be maintained by increasing the surface area of the dialyzer membrane and decreasing the frequency of treatment which can help the poor socioeconomic status patients in getting effective hemodialysis at a low cost. Objectives: To observe whether by increasing the surface area of dialyzer the dose of dialysis can be reduced against the standard hemodialysis prescription. Study design: Randomized Control Trial. Study Duration: Six months from March 2017 to August 2017. Settings: Department of Nephrology, The Indus Hospital Karachi. Subjects: ESRD patients undergoing Hemodialysis for at least 6 months at The Indus Hospital Karachi. Methods: In this prospective randomized control study, a total of 60 patients of end stage renal disease receiving hemodialysis for more than six months were included and divided into 2 groups randomly (Arm-A: twice weekly dialysis using a larger surface area dialyzer and Arm-:B thrice weekly dialysis using regular surface area dialyzer). Results: A total of 59 (30 in Arm A and 29 in Arm B) patients were enrolled in the study out of which majority of the patients were male (59.3%). On average significantly higher URR and eKt/V were reported in Arm A whereas, higher mean standard (weekly) stdKt/V was reported in Arm-B. Conclusion: Standard protocols should be followed to maintain the adequacy of Hemodialysis.

Changing the paradigm of bicarbonate (HCO3−) hemodialysis prescription in Portugal: a 24-month prospective study

Background Metabolic acidosis is common in hemodialysis (HD) patients. The KDOQI guidelines therapeutic goal is pre-dialysis HCO3− ≥ 22 mmol/L. The aim of the study was to evaluate an individualized HCO3− hemodialysis prescription as a preventing factor of metabolic changes. Methods Twenty-four-month prospective study of patients on online high-flux hemodiafiltration. Every 3 months, HCO3− blood levels were analyzed and hemodialysis HCO3− was changed using the following rules: HCO3− > 30 mmol/L: reduce 4 mmol/L HCO3− HCO3− ≥ 25 mmol/L: reduce 2 mmol/L HCO3− 20 mmol/L < HCO3− < 25 mmol/L: no change HCO3− ≤ 20 mmol/L: increase 2 mmol/L HCO3− HCO3− < 18 mmol/L: increase 4 mmol/L HCO3− Data collected comprised demographic information, renal disease etiology, comorbidities, HD treatment information, and lab results. Statistical analysis was performed using SPSS. Results Thirty-one patients were enrolled and completed the follow-up period. At baseline, average serum pH was 7.38 ± 0.06, serum HCO3− 25.92 ± 1.82 mmol/L, and every patient had a 32 mmol/L dialytic HCO3− prescription. At time point 9, average serum HCO3− was 23.87 ± 1.93 mmol/L and 58% of the patients had a dialytic HCO3− prescription of 28 mmol/L. Serum HCO3− differed with statistical significance during time and approached the reference serum HCO3− (23 mmol/L) that we have defined as ideal. Through time, the HCO3− prescription deviated more from the 32 mmol/L initial prescription that was defined as standard. Conclusions Our findings suggest that the standard HCO3− prescription of 32 mmol/L should be rethought, as an individualized HCO3− prescription could be beneficial for the patient.

Phosphate and Calcium Control in Short Frequent Hemodialysis with the NxStage System One Cycler: Mass Balance Studies and Comparison with Standard Thrice-Weekly Bicarbonate Dialysis

Background: Short frequent dialysis with NxStage System One cycler (NSO) has become increasingly popular as home hemodialysis prescription. Short dialysis sessions with NSO might not allow adequate phosphate (P) removal. Methods: Single-session and weekly balances of P and calcium (Ca) were compared in 14 patients treated with NSO (6 sessions/week) and in 14 patients on standard bicarbonate dialysis (BHD). Results: NSO and BHD showed similar plasma P fall, with end-dialysis plasma P slightly lower in BHD (2.2 ± 0.5 vs. 2.7 ± 0.8 mg/dL, p < 0.02). Single-session P removal was lower in NSO, but weekly removal was higher (3,488 ± 1,181 mg vs. 2,634 ± 878, p < 0.003). Plasma Ca increase was lower in NSO, with similar PTH fall. Ca balance varied according to start plasma Ca, dialysate to blood Ca gradient and net ultrafiltration. Conclusions: short, frequent home hemodialysis with NSO, on a 6/week-based prescription, allows higher weekly P removal than BHD. With the dialysate Ca concentration in use (6 mg/dL), total plasma Ca and iCa concentration increase is lower in NSO.