VIDEO: Urea reduction ratios may be achieved with lower dialysate rates
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ORLANDO — In this video from ASN Kidney Week, Sevag Demirjian, MD, discusses middle and conventional dialysate flow in critically ill patients using intermittent dialysis.
“What we wanted to look at was: What are the different prescription components that translate in real life to dialysis adequacy or small solute clearance?” Demirjian told Healio.
In a retrospective observational study, researchers compared urea clearance between middle and conventional flow rates, and the impact of filter size, in about 4,000 patients using bedside intermittent dialysis in a hospital setting. The study included approximately 21,000 dialysis treatments. Patients were categorized based on dialysate flow rates and type of dialyzer used (Optiflux High Flux 160 vs. 250, both by Fresenius Medical Care North America).
Analyses revealed that dialysis duration and achieved blood flow were the most important modifiable factors of urea reduction ratio. Further, an increase in dialysate rate from 300 mL to 600 mL per minute depended on blood flow achieved, with only a small change in urea reduction ratio.
“The bottom line is in real world separation, especially if you look at the amount
of blood flow that you can deliver in these patients, a lot of it is limited because of the catheters used in AKI patients. Perhaps a lot of the delivered blood flow is much lower than you expect, even if you dial in a higher blood flow.”
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Demirjian S, et al. SA-PO426. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
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