Increasing blood flow increases kt/V(urea) and potassium removal but fails to improve phosphate removal.
BACKGROUND
Hyperphosphatemia and hyperkalemia are major determinants of morbidity and mortality in hemodialysis patients. Half of the dialysis population suffers from hyperphosphatemia which is now recognized as an important cardiovascular disease risk factor. It is, therefore, necessary to improve the removal of these molecules. In this study, we investigated the effect of enhancing blood flow on Kt/V for urea (Kt/Vu), potassium and phosphate removal.


METHODS
Thirteen patients were investigated in a randomized, cross-over, prospective study using 3 blood flows (Qb) of 200,250 and 300 ml/min which gave 39 standardized high-flux hemodialysis treatments. Effective blood flows were measured by ultrasonic flow meter. Quantification of delivered dialysis dose was performed by partial dialysate and ultrafiltrate collection for the determination of potassium and phosphate removal and by blood urea concentrations for determination of Kt/Vu.


RESULTS
Kt/Vu rose significantly from 1.10 +/- 0.14 to 1.22 +/- 0.14 and finally to 1.39 +/- 0.16 (p = 0.0001) with increasing Qb similar to the increase in potassium removal from 53.0 +/- 2.4 to 63.4 +/- 2.6 and to 74.2 +/- 3.8 mMol (p = 0.01). Phosphate removal only improved from 28.1 +/- 1.3 to 31.4 +/- 1.5 (p = 0.050) when Qb was increased from 200 to 250 ml/min but remained unchanged at 31.2 +/- 1.5 mMol (NS compared to phosphate removal at Qb = 250 ml/min) when Qb was increased to 300 ml/min.


CONCLUSIONS
Increasing delivered Kt/Vu and potassium removal with higher Qb fails to produce the same desired effect with phosphate removal during high-flux hemodialysis.
Gutzwiller
J P
JP
Division of Nephrology, Kantonsspital Liestal, University of Basle, Switzerland. jeanlucjpg@hotmail.com
Schneditz
D
D
Huber
A R
AR
Schindler
C
C
Garbani
E
E
Zehnder
C E
CE
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D011188:Potassium / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D014508:Urea / Q000097:blood*
D010710:Phosphates; D014508:Urea; D011188:Potassium