Multipass haemodialysis: a novel dialysis modality

James Goya Heaf, Mette Axelsen, Robert Smith Pedersen, James Goya Heaf, Mette Axelsen, Robert Smith Pedersen

Abstract

Introduction: Most home haemodialysis (HD) modalities are limited to home use since they are based on a single-pass (SP) technique, which requires preparation of large amounts of dialysate. We present a new dialysis method, which requires minimal dialysate volumes, continuously recycled during treatment [multipass HD (MPHD)]. Theoretical calculations suggest that MPHD performed six times weekly for 8 h/night, using a dialysate bath containing 50% of the calculated body water, will achieve urea clearances equivalent to conventional HD 4 h thrice weekly, and a substantial clearance of higher middle molecules.

Methods: Ten stable HD patients were dialyzed for 4 h using standard SPHD (dialysate flow 500 mL/min). Used dialysate was collected. One week later, an 8-h MPHD was performed. The dialysate volume was 50% of the calculated water volume, the dialysate inflow 500 mL/min-0.5 × ultrafiltration/min and the outflow 500 mL/min + 0.5 × ultrafiltration/min. Elimination rates of urea, creatinine, uric acid, phosphate and β2-microglobulin (B2M) and dialysate saturation were determined hourly.

Results: Three hours of MPHD removed 49, 54, 50, 51 and 57%, respectively, of the amounts of urea, creatinine, uric acid, phosphate and B2M that were removed by 4 h conventional HD. The corresponding figures after 8 h MPHD were 63, 78, 74, 78 and 111%.

Conclusions: Clearance of small molecules using MPHD 6 × 8 h/week will exceed traditional HD 3 × 4 h/week. Similarly, clearance of large molecules will significantly exceed traditional HD and HD 5 × 2.5 h/week. This modality will increase patients' freedom of movement compared with traditional home HD. The new method can also be used in the intensive care unit and for automated peritoneal dialysis.

Keywords: beta-2 microglobulin; dialysis adequacy; home haemodialysis.

Figures

FIGURE 1:
FIGURE 1:
Schematic representation of the MPHD model. The black arrow shows the blood flow through the dialysis filter. The dialysate is kept in the container. It is pumped into the filter using an inflow pump (P-I) and out of the filter using an outflow pump (P-O). The difference in pump flow rates determines the ultrafiltration. The combined weight of dialysate and ultrafiltrate is registered continuously by the scales.
FIGURE 2:
FIGURE 2:
Removal of urea, creatinine, uric acid, phosphate and B2M in dialysate and ultrafiltration as a function of time, compared with the amount removed after 4 h SPHD.
FIGURE 3:
FIGURE 3:
Toxin-free dialysate flow as a function of time.
FIGURE 4:
FIGURE 4:
Relationship between calculated and measured TBW.

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