Enhanced solute removal with intermittent, in-center, 8-hour nocturnal hemodialysis

Authors

  • Laura TROIDLE,

    1. Milford Hemodialysis Center, Renal Research Institute, Milford, Connecticut, USA
    2. Hospital of ST Rapheal, New Haven, Connecticut, USA
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  • Fredric FINKELSTEIN,

    1. Milford Hemodialysis Center, Renal Research Institute, Milford, Connecticut, USA
    2. Hospital of ST Rapheal, New Haven, Connecticut, USA
    3. Yale University School of Medicine, New Haven, Connecticut, USA
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  • Mark HOTCHKISS,

    1. Milford Hemodialysis Center, Renal Research Institute, Milford, Connecticut, USA
    2. Hospital of ST Rapheal, New Haven, Connecticut, USA
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  • John Ken LEYPOLDT

    1. Salt Lake City VA Medical Center, University of Utah, Salt Lake City, Utah, USA
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F. Finkelstein, MD, Metabolism Associates, 136 Sherman Avenue, New Haven, CT 06511, USA.
E-mail: fof@comcast.net

Abstract

Advances in the dialysis technique and increasing urea Kt/V have not improved outcomes for end-stage renal disease patients maintained on hemodialysis (HD) therapy. Attention has, thus, focused on enhancing solute removal via prolonged HD sessions. A reduction in the serum levels of phosphorus and β-2-microglobulin (B2M) with longer HD treatments has been linked to improved patient outcomes. We have shown that serum phosphorus levels are significantly lowered in patients maintained on thrice-weekly, in-center, 8-hour nocturnal HD performed at a blood flow rate of 400 mL/min. The kinetics of this modality were examined. A total of 8 patients participated in the study (age 45±7 years). Serum creatinine levels decreased from 9.2±1.9 to 3.0±1.0 mg/dL at 8 hours while serum phosphorus decreased from 5.7±1.9 to 2.5±0.7 mg/dL at 8 hours. The initial decrease from predialysis values to 1 hour after the start of HD was significant for both creatinine (P<0.0001) and phosphorus (P<0.001). Serum B2M decreased from 26.8±5.5 mg/L predialysis to 14.9±7.0 mg/L at 8 hours (P<0.01). Dialysate-side clearances of phosphorus and creatinine were 136±13  and 143±27 cm3/min, respectively. Phosphorus clearances were steadily maintained during the 8-hour session. A total of 904±292 mg of phosphorus was removed during the 8-hour treatment, with 501±174 mg (55%) removed during the first 4 hours and the remaining 45% continuously removed during the latter one-half of the session. The overall calculated B2M clearance was 55.1±40.3 cm3/min using the immediate post-B2M value and 28.4±34.2 mg/L using the 30-minute postdialysis value for the calculation. Serum levels of phosphorus and B2M decrease dramatically during an 8-hour session. Future studies are necessary to determine whether the enhanced solute removal with longer HD sessions translates into an improved outcome for HD patients.

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