Abstract: TH-PO290
Effect of Dialysate Flow Rate (DFR) Reduction on Adequacy in a Chronic Hemodialysis Unit
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Beavin, Sam, University of Kentucky, Lexington, Kentucky, United States
- Ahmed, Sadiq, University of Kentucky, Lexington, Kentucky, United States
Background
The Covid-19 pandemic has introduced a number of challenges in managing populations with both acute kidney failure and those dependent on chronic dialysis. Due to a shortage of outpatient dialysis supplies, on February 14, 2022, the Dpt. of Veteran’s Affairs issued a memorandum to dialysis units requiring a contingency standard of care. This required a universal reduction of dialysate flow rate to 500 cc/min. Prior to this change, the standard prescription at the Lexington, KY VA unit was 750 cc/min. We evaluated the effect of this change on the adequacy of our dialysis population.
Methods
Data was collected for sp Kt/V urea and urea reduction ratio for 17 chronic hemodialysis patients for the two months prior and three months following the reduction of dialysate flow rate to 500 cc/min from the previous standard of 750 cc/min. There was no change of blood flow rate or dialysis time during this 5 month period for all the patients included.
Results
A trend towards lower clearance values as measured by single-pool Kt/V and urea reduction ratio was noted between January and April of 2022. Table 1 shows the average spKt/V and URR for each month. The majority of patients maintained adequate spKt/V of >1.2 and urea reduction ratio of >65%. However, 4 patients (23.5% of the population) failed to reach Kt/V and URR goal in April 2022.
Conclusion
Though this represents only 17 patients from one dialysis unit, the data suggests a significant decline in adequacy due to this reduction in dialysis flow rate to 500 cc/min. Until the current dialysis supply shortage has been addressed, adaptive measures such as utilizing higher efficiency dialyzers or increasing blood flow rates may be necessary.
Table 1
| Mean URR | Mean Kt/V | |
| December | 0.75 | 1.61 |
| January | 0.74 | 1.58 |
| February | 0.72 | 1.50 |
| March | 0.72 | 1.51 |
| April | 0.70 | 1.42 |
Average Kt/V trend