Kidney Week

Abstract: PUB141

Can Post-Dilution Online Hemodiafiltration Provide a Valid Means of Preserving the Global Environment?

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Sakurai, Kenji, Hashimoto Clinic, Sagamihara, Kanagawa, Japan

Kenji Sakurai, MD, PhD

• Kurihara, Yoshitaka, Hashimoto Clinic, Sagamihara, Kanagawa, Japan

Yoshitaka Kurihara, PhD

• Hosoya, Hiromi, Hashimoto Clinic, Sagamihara, Kanagawa, Japan

Hiromi Hosoya

• Yamauchi, Fumi, Hashimoto Clinic, Sagamihara, Kanagawa, Japan

Fumi Yamauchi

• Saito, Takeshi, Hashimoto Clinic, Sagamihara, Kanagawa, Japan

Takeshi Saito, MD

• Ishii, Daisuke, Dept. of Urology Kitasato Univ. Hospital, Sagamihara, Kanagawa, Japan

Daisuke Ishii, MD

• Hyodo, Toru, Fureai Clinic IZUMI, Yokohama, Kanagawa, Japan

Toru Hyodo, MD, PhD

• Kokubo, Kenichi, Kitasato Univ. School of Allied Health Sciences, Sagamihara, Kanagawa, Japan

Kenichi Kokubo, PhD

Background

There are numerous open issues with dialysis therapy related to reducing climate change and preserving the global environment that need to be urgently addressed. Hemodiafiltration (HDF) has become common due to its excellent removal performance. In Japan, in-end 2022, 55.1% of dialysis patients underwent HDF, and 69% were receiving pre-dilution on-line HDF (pre-HDF). Reducing dialysate usage is a readily applicable method of preserving water resources and reducing the burden of waste fluid disposal. We switched from pre-HDF to post-HDF with high-flux hemodiafilter, which allowed the total dialysate flow rate (t-Qd) to be reduced by 20% and 30%, and evaluated the removal efficiency of each mode.

Methods

A study involved 14 patients who received pre-HDF (t-Qd 500 mL/min) using FIX-210Seco (Nipro) at our institution. While keeping the Qb and dialysis time unchanged, we performed post-HDF with t-Qd of 400 mL/min and evaluated the removal efficiency. The substitution fluid volume (Vs) was then adjusted to avoid excessive albumin loss so that an optimal convection volume (CV) (the sum of Vs and the net ultrafiltration volume) could be set for each patient. Next, the effect of this method in reducing the volume of dialysate and raw water required was evaluated using the volume data after the settings had been modified. Finally, the removal efficiency at this CV was evaluated again with t-Qd of 350 mL/min.

Results

The removal efficiency results obtained for each mode are shown in Figure. Even during the first month after modification of the settings, the dialysiate amount and the raw water volume required could be reduced by 4368L and 6720L, respectively.

Conclusion

Post-HDF using high-flux hemodiafilter at lower t-Qd exhibited favorable solute-removal efficiency. This type of post-HDF should be more widely used as a means of reducing climate change and preserving the global environment.