Slow Extended Nocturnal Home Hemodialysis Shows Superior Adequacy Compared to In-Center Dialysis: A Mathematical Analysis

Publisher: Karger

E-ISSN: 1421-9735|34|3-4|219-224

ISSN: 0253-5068

Source: Blood Purification, Vol.34, Iss.3-4, 2012-10, pp. : 219-224

Disclaimer: Any content in publications that violate the sovereignty, the constitution or regulations of the PRC is not accepted or approved by CNPIEC.

Previous Menu Next

Abstract

Extended nocturnal home hemodialysis has gained renewed interest. However, no removal data for single/double needle (lumen) (SL and DL, respectively) or for low/high blood flow in extended dialysis are available. Therefore, we studied dialysis adequacy in different nocturnal home hemodialysis strategies. Coupling a kinetic with a dialyzer model, we calculated a reduction ratio from pre- to post-dialysis (RR) and total solute removal (TSR) of urea, methylguanidine (MG), β2-microglobulin, and phosphate. Simulations were done for dialysis with blood flow Qb350 ml/min (DL-4h), extended DL high flow with Qb350 (DL-HF-8h) and low flow with Qb175 (DL-LF-8h), and SL with Qb273 (SL-8h). Compared to DL-4h, TSR was 28–59% larger for DL-HF-8h. TSR was most increased for β2-microglobulin (18%) with DL-LF-8h, and for MG (35%) with SL-8h. Furthermore, RRs were equal (DL-LF-8h), higher (SL-8h), and even more increased (DL-HF-8h) for all studied solutes. In the home setting, DL-LF-8h and SL-8h are safe and promising strategies.