Effect of Reduced Dialysate Flow on Dialysis Adequacy: A Pilot Study
- Type de publi. : Article dans une revue
- Date de publi. : 21/10/2025
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Auteurs :
Mohamed BelmouazCharles DibonJean-Philippe DevauxFabien DutheRomain Wong-ChengClemence LemarchandLaure EcotiereJean-Marc GombertFlorence JacometSarah Ayraud-ThevenotLisa DurocherAntoine ThierryPierre-Jean SaulnierFrank Bridoux
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Organismes :
Pôle Biospharm (biologie pharmacie santé publique) [CHU de Poitiers] = Biology, Pharmacy, Public Health Department [Poitiers University Hospital]
Interaction Homme Environnement Santé [Équipe du laboratoire EBI Poitiers]
EATHER : EnvironmentAl Health rEsearch gRoup [Axe de recherche du CIC de Poitiers – CIC 1042]
Écologie et biologie des interactions [UMR 7267]
Université de Poitiers = University of Poitiers
Ischémie reperfusion, métabolisme et inflammation stérile en transplantation [U 1313]
Université de Poitiers = University of Poitiers
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
Service de néphrologie - hémodialyse et transplantation rénale [CHU Poitiers]
- Publié dans Blood Purification le 28/10/2020
Résumé : Introduction: The standard dialysate flow (Qd) for hemodialysis (HD) is currently set at 500 mL/min. One potential, sustainable, and cost-effective solution for eco-friendly HD may involve reducing Qd to limit wastewater. However, the effect of reduced Qd on small molecule and middle molecule (MM) removal remains to be investigated. Methods: In this prospective observational study, 74 patients on different maintenance dialysis modalities with Qd set at 500 mL/min (Qd500) were assigned to receive Qd at 400 mL/min (Qd400) for 3 months. Dialysis adequacy, including small solute removal and MM reduction ratio (RR), was evaluated at enrollment and after 3 months. Results: Compared to Qd500, Qd400 after 3 months achieved similar single-pool Kt/V (1.41 ± 0.30 vs. 1.43 ± 0.33, p = 0.58), equilibrated KT/V, urea RR, creatinine RR, and phosphate RR. Qd400 vs. Qd500 provided significantly higher beta2-microglobulin RR (77.0 [71.4–81.7] vs. 74.7 [68.4–79.4] %, p = 0.009) and lower kappa free light chain (FLC) RR (54.2 [42.1–64.4] vs. 57.6 [41.6–65.0] %, p = 0.03), whereas myoglobin and lambda FLC RR were similar. Qd400 resulted in higher pre-dialysis urea (20.2 ± 5.5 vs. 18.2 ± 6.2 mmol/L, p = 0.002), creatinine (694.0 ± 179.5 vs. 665.6 ± 220.4 µmol/L, p = 0.029), beta2-microglobulin (26.5 [23.0–30.0] vs. 23.5 [20.0–28.0] mg/L, p = 0.0001), and myoglobin (174.0 [122.0–251.0] vs. 159.5 [119.0–195.0] µg/L, p = 0.033) levels. Pre-dialysis levels of albumin, potassium, bicarbonate, phosphate, and calcium were similar between Qd400 and Qd500. Conclusion: Three months of Qd at 400 mL/min appears to provide similar small molecule and MM removal, but with an increase in pre-dialysis urea, creatinine, beta2-microglobulin, and myoglobin levels. Although this strategy could help preserve water, its potential impact on long-term clinical outcomes deserves further evaluation.
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