Kidney Week

Abstract: SA-PO617

Efficiency of a Fully Integrated Hemodialysis (HD) Machine in the Acute Care Setting

Session Information

• Hemodialysis: Case Reports, Series, QI Projects
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Atefi, Nazli, VA Medical Center Baltimore, Baltimore, Maryland, United States

Nazli Atefi,

• Elavia, Nasha, VA Medical Center Baltimore, Baltimore, Maryland, United States

Nasha Elavia,

• Haq, Zain, VA Medical Center Baltimore, Baltimore, Maryland, United States

Zain Haq,

• Chahal, Jagman S., VA Medical Center Baltimore, Baltimore, Maryland, United States

Jagman S. Chahal,

• Ejaz, Abutaleb Ahsan, VA Medical Center Baltimore, Baltimore, Maryland, United States

Abutaleb Ahsan Ejaz,

• Patel, Ami Mahendrakumar, VA Medical Center Baltimore, Baltimore, Maryland, United States

Ami Mahendrakumar Patel,

Background

Tablo^TM , which is a fully-integrated, adaptive hemodialysis (HD) machine with an internal water purification system without requiring traditional water treatment resources, has a 300 mL/min restriction in the maximum attainable dialysate flow rate (DFR). We investigated the efficiency of Tablo^TM in the acute hospital setting.

Methods

We conducted a prospective, single-center analysis. All Veterans with ESKD, who completed > 3hrs of hemodialysis with available blood urea nitrogen pre- and post-treatment, from February 2023 to May 2023 were included. Urea reduction ratio (URR) and calculated Kt/V were compared for selected variables.

Results

38 Veterans with total of 69 HD sessions met the inclusion criteria for analysis. Participants were 94.2% males, mean age 67.2+10.2 years, dialyzed for 211.3+9.1 mins, blood flow rate (BFR) 354.1+13.1mL/min, with Optiflux F160 (43.5%) and F180 (56.5% ) dialyzers, average ultrafiltration 1.9+0.6 L, arteriovenous fistula (26%), arteriovenous graft (5.7%) and central venous catheter (68.3%). Kt/V and URR for full cohort was 1.21+0.2 and 59.5+6.7%, respectively. 43.5% and 27.5% of the sessions achieved adequate Kt/V (>1.2) and URR (>65%), respectively. Mutivariable analysis by subclasses are shown in Figure1. Access type, duration of treatment, dialyzer type or BFR were not predictors of adequate Kt/V on multivariate analysis. Despite a favorable trend, significant statistical differences were not observed in Kt/V or URR between the use of Optiflux F160 and F180 dialyzers at same BFR (350 mL/min) and treatment duration (3.5 or 4 hrs).

Conclusion

The restriction of DFR to 300 mL/min with Tablo^TM system compromises adequacy of dialysis in acute care setting. This may be mitigated by prolonging session times, albeit at the expense of higher resource utilization. Future studies are necessary to compare adequacy of Tablo^TM and conventional dialysis machines using higher typical DFR in a larger cohort.

Figure 1 Multivariable analysis of dialysis adequacy with Tablo ^TM