Smart, Individualized Green Hemodiafiltration - Effects of Individualized Dialysate Flow Through AutoFlow on Dialysate Consumption and Parameters of Dialysis Adequacy in the Setting of Online Hemodiafiltration.

High-dose online HDF compared with hemodialysis reduces all-cause mortality, but increases water consumption. We postulate that the conundrum could be solved by individualizing dialysate flow. Thirty CKD5D patients undergoing online HDF post-dilution were changed from fixed dialysate flow (500 mL/min) to individualized dialysate flow, resulting in a dialysate flow that was always 20% higher than the blood flow. Kt/Vurea, K+, Phos, and pill burden in one quater pre as well as four quarters after the change were evaluated. The practice change resulted in a reduction of the fixed dialysate flow from 500 to 360 (240-383) mL/min. Parameters of dialysis adequacy did not change; neither did the medication. An individualization of the dialysate flow saved about 36 L dialysate per session; hence, even in light of 23 L used for online HDF, the net burden on the environment could be reduced. Neither dialysis adequacy nor pill burden was negatively affected.