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BackgroundHemodialysis units require large quantities of water. To reduce water consumption without compromising the adequacy and safety of dialysis, we studied a novel hemodialysis prescription with high temperature and low flow dialysate.MethodsThis was a single-center non-randomized open-label cross-over pilot trial in patients with ESKD on maintenance hemodialysis. Each participant was subjected to three different dialysis prescriptions for one month each – normal temperature with normal flow dialysate (NTNF prescription), high temperature with normal flow dialysate (HTNF prescription), and high temperature with low flow dialysate (HTLF prescription). The primary outcome, assessed at the end of each dialysis session, was the delivery of 'adequate' dialysis, as defined by a single-pool Kt/V (spKt/V) ≥ 1.2. Outcomes were evaluated by comparing the NTNF and HTLF prescriptions.ResultsA total of 863 sessions of hemodialysis were performed in 30 patients over 3 months, with 287-288 sessions in each of the three dialysis prescriptions. The primary outcome was not significantly different between the NTNF prescription 202 sessions (70.14%) and the HTLF prescription 198 sessions (68.75%) (OR 1.07; 95% CI, 0.75 to 1.52; P=0.45). The mean spKt/V and urea reduction ratio (URR) were not significantly different. Clinically evident haemodynamic instability occurred in only one dialysis session in the HTNF prescription.ConclusionIncreasing dialysate temperature while reducing dialysate flow rate can be used as a water conservation strategy without compromising the adequacy and safety of dialysis, in young, hemodynamically stable patients. Reducing the dialysate flow rate from 500 mL/min to 300 mL/min reduces water consumption by 40%.
Solomon et al. (Tue,) studied this question.