title: Is it useful to increase dialysate flow rate to improve the delivered Kt?
abstract: BACKGROUND
  Increasing dialysate flow rates (Qd) from 500 to 800 ml/min has been recommended to increase dialysis efficiency. A few publications show that increasing Qd no longer led to an increase in mass transfer area coefficient (KoA) or Kt/V measurement. Our objectives were: 1) Studying the effect in Kt of using a Qd of 400, 500, 700 ml/min and autoflow (AF) with different modern dialysers. 2) Comparing the effect on Kt of water consumption vs. dialysis time to obtain an individual objective of Kt (Ktobj) adjusted to body surface.
  
  
  METHODS
  This is a prospective single-centre study with crossover design. Thirty-one patients were studied and six sessions with each Qd were performed. HD parameters were acquired directly from the monitor display: effective blood flow rate (Qbe), Qd, effective dialysis time (Te) and measured by conductivity monitoring, final Kt.
  
  
  RESULTS
  We studied a total of 637 sessions: 178 with 500 ml/min, 173 with 700 ml/min, 160 with AF and 126 with 400 ml/min. Kt rose a 4% comparing 400 with 500 ml/min, and 3% comparing 500 with 700 ml/min. Ktobj was reached in 82.4, 88.2, 88.2 and 94.1% of patients with 400, AF, 500 and 700 ml/min, respectively. We did not find statistical differences between dialysers. The difference between programmed time and Te was 8' when Qd was 400 and 500 ml/min and 8.8' with Qd = 700 ml/min. Calculating an average time loss of eight minutes/session, we can say that a patient loses 24' weekly, 312' monthly and 62.4 hours yearly. Identical Kt could be obtained with Qd of 400 and 500 ml/min, increasing dialysis time 9.1' and saving 20% of dialysate.
  
  
  CONCLUSIONS
  Our data suggest that increasing Qd over 400 ml/min for these dialysers offers a limited benefit. Increasing time is a better alternative with demonstrated benefits to the patient and also less water consumption.
authors.affiliation: Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain. malbalater@senefro.org.
authors.forename: Marta
authors.initials: M
authors.lastname: Albalate
authors.affiliation: Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain. rperezga@salud.madrid.org.
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-García
authors.affiliation: Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain. patricia.desequera@salud.madrid.org.
authors.forename: Patricia
authors.initials: P
authors.lastname: de Sequera
authors.affiliation: Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain. e_corchete@yahoo.es.
authors.forename: Elena
authors.initials: E
authors.lastname: Corchete
authors.affiliation: Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain. roberto.alcazar@salud.madrid.org.
authors.forename: Roberto
authors.initials: R
authors.lastname: Alcazar
authors.affiliation: Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain. mayraortegadiaz@hotmail.com.
authors.forename: Mayra
authors.initials: M
authors.lastname: Ortega
authors.affiliation: Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain. marta.puerta@salud.madrid.org.
authors.forename: Marta
authors.initials: M
authors.lastname: Puerta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D016009:Chi-Square Distribution; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D013030:Spain; D055815:Young Adult
chemical_list: D015314:Dialysis Solutions