title: Improved urea reduction ratio and Kt/V in large hemodialysis patients using two dialyzers in parallel.
abstract: Delivered dose of hemodialysis (HD) in large patients with end-stage renal disease is often less than adequate. Fourteen chronic HD patients with weights greater than 80 kg participated in a prospective, cross-over study comparing urea reduction ratio (URR +/- SEM) and the fractional clearance index for urea (eKt/V(urea) +/- SEM) on a single polysulfone dialyzer for a control (HDC) period of 4 weeks versus clearances obtained with two dialyzers in parallel during an intervention (HDP) period of 4 weeks. Clearance of the surrogate middle molecule iohexol (C(Io)) was also measured. Health status was assessed with the SF-36. Blood and dialysate flow rates and duration of HD sessions were constant. URR increased from 0.67 +/- 0.006 during HDC to 0.72 +/- 0.006 with HDP (P < 0.0001). eKt/V(urea) increased from 1.16 +/- 0.021 to 1.34 +/- 0.021 (P < 0.0001). Increased URR and eKt/V(urea) occurred in all 14 during HDP (P < 0.05). C(Io) during HDP averaged 182 +/- 7.7 mL/min compared with 131 +/- 5.4 mL/min in HDC sessions (P < 0.00001). Health status improved in six of eight categories. Expense increased approximately $14.27 per dialysis with HDP. In 11 of 14 patients continued on two dialyzers in parallel for 1 year, monthly eKt/V averaged 1.46 +/- 0.066, and health status further improved in five of eight categories. In large patients, two dialyzers in parallel increased urea and iohexol clearance. Increased urea clearance was maintained for 1 year, and health status improved.
authors.affiliation: Division of Nephrology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Powers
authors.forename: M J
authors.initials: MJ
authors.lastname: Wilkowski
authors.forename: A W
authors.initials: AW
authors.lastname: Helmandollar
authors.forename: K G
authors.initials: KG
authors.lastname: Koenig
authors.forename: W K
authors.initials: WK
authors.lastname: Bolton
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D014508:Urea / Q000378:metabolism*
chemical_list: D014508:Urea