How to increase dialysis adequacy; A randomized clinical trial

Introduction: Studies have shown when hemodialysis treatment is sufficiently effective, complications of uremic syndrome, additional treatment costs and hospitalization length are reduced. Several methods have been proposed to improve hemodialysis adequacy. Objectives: In this study, the effects of the synchronic use of the stepwise profile dialysis fluid flow rate with increased blood flow rate (BFR) were studied on hemodialysis adequacy. Patients and Methods: This is a cross-over clinical trial study conducted on 34 hemodialysis patients selected from a hemodialysis center of Qazvin University of Medical Sciences, Qazvin, Iran. The patients were randomly allocated into two groups (n= 17 patients in each group) in two sequences. In the first sequence, the subjects received four routine hemodialysis sessions in group one and four hemodialysis sessions with the stepwise profile of the fluid flow rate with increased BFR in group two. In the second sequence, the treatment methods were exchanged. Hemodialysis sessions were performed in both sequences, consecutively. Each session was at least three hours. Hemodialysis adequacy was measured using Kt/V software on the hemodialysis machines after each session. Results: The mean score of dialysis adequacy was 0.89 in the routine method and 1.26 in the profile with increased BFR. There was a statistically significant difference between the methods (t= -7.9, df = 33, P < 0.001). Conclusion: The results of the study suggest that the stepwise profile of the dialysis fluid flow rate with increased BFR should be used synchronously to improve hemodialysis adequacy.