Solute kinetics with short-daily home hemodialysis using slow dialysate flow rate

"NxStage System One (TM)" is increasingly used for daily home hemodialysis. The ultrapure dialysate volumes are typically between 15 L and 30 L per dialysis, substantially smaller than the volumes used in conventional dialysis. In this study, the impact of the use of low dialysate volumes on the removal rates of solutes of different molecular weights and volumes of distribution was evaluated. Serum measurements before and after dialysis and total dialysate collection were performed over 30 times in 5 functionally anephric patients undergoing short-daily home hemodialysis (6 d/wk) over the course of 8 to 16 months. Measured solutes included beta(2) microglobulin (beta M-2), phosphorus, urea nitrogen, and potassium. The average spent dialysate volume (dialysate plus ultrafiltrate) was 25.4 +/- 4.7 L and the dialysis duration was 175 +/- 15 min. beta(2) microglobulin clearance of the polyethersulfone dialyzer averaged 53 +/- 14 mL/min. Total beta M-2 recovered in the dialysate was 106 +/- 42 mg per treatment (n=38). Predialysis serum beta M-2 levels remained stable over the observation period. Phosphorus removal averaged 694 +/- 343 mg per treatment with a mean predialysis serum phosphorus of 5.2 +/- 1.8 mg/dL (n=34). Standard Kt/V averaged 2.5 +/- 0.3 per week and correlated with the dialysate-based weekly Kt/V. Weekly beta M-2, phosphorus, and urea nitrogen removal in patients dialyzing 6 d/wk with these relatively low dialysate volumes compared favorably with values published for thrice weekly conventional and with short-daily hemodialysis performed with machines using much higher dialysate flow rates. Results of the present study were achieved, however, with an average of 17.5 hours of dialysis per week.