The Effect of Increasing Blood Flow Rate on Dialysis Adequacy in Hemodialysis Patients with Low Kt/V

Song, Woo Jung; Kim, Nam Hee; Kim, Young Ok; Kim, Young Soo; Yoon, Sun Ae; Yang, Chul Woo; Jin, Dong Chan; Kim, Yong Soo; Chang, Yoon Sik; Bang, Byung Kee

Abstract

BACKGROUND
Dialysis adequacy indexed by Kt/V in hemodialysis patients is recommended as a single-pool Kt/V of at least 1.2 per session thrice weekly. But many patients can not achieve this adequacy target. Although dialysis time is the most important as a factor influencing Kt/V, it is difficult to prolong dialysis time in practice because of its economic impact and poor patient compliance. The aim of this study is to investigate the effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients with low Kt/V. METHODS: This study enrolled 36 hemodialysis patients with single-pool Kt/V less than 1.2 per session thrice weekly, which was measured in dialyzer blood flow rate of 200-230 mL/min. We increased 15% of blood flow rate in patients less than 65 kg of body weight and 20% in patients more than 65 kg. And then we compared Kt/V and urea reduction ratio (URR) between before and after increasing blood flow rate. RESULTS: The mean age was 48+/-11 years (23-73 years) and the number of male was 25. Of the total patients, 24 patients had dry weight less than 65 kg. Mean dialysis duration was 52+/-50 months (3-216 months). Mean Kt/V before increasing blood flow rate was 1.02+/-0.09. It increased to 1.14+/-0.12 after increasing blood flow rate (p<0.001). Of the total 36 patients, 13 patients (36.1%) achieved adequacy target (Kt/V> or =1.2). Mean URR before increasing blood flow rate was 56.9+/-4.0%. It also increased to 60.8+/-4.1% (p<0.001). CONCLUSION: Our data suggest that increment of blood flow rate to 15-20% of previous flow rate is effective in achieving dialysis adequacy in patients with low Kt/V.