Intensive Hemodialysis: Effects of Treatment Time and Frequency on Time-Averaged Concentrations of Solutes.

Most of chronic renal disease patients receive 4-h hemodialysis (HD) sessions thrice a week. This is the minimum therapy needed to maintain life. This conventional HD therapy protocol is, however, inadequate to prevent dialysis-related complications. On the other hand, some intensive HD therapies, such as "short daily dialysis," "quotidian dialysis," etc., are being adopted in some dialysis institutions for maximizing the beneficial effects of HD on the quality of life/activities of daily living of the patients. In this paper, the effects of dialysis treatment time and frequency on the adequacy of solute removal in these intensive HD therapies protocols were examined by kinetic modeling using a 1-compartment model. In this model, it is presupposed that urea is distributed throughout the total body fluid compartment and β2-microglobulin (β2-MG) is distributed throughout the extracellular compartment. The time-averaged concentrations (TACs) of BUN and β2-MG can be estimated by inputting the body weight, generation rate of the solute, dialyzer clearance for the solute, and the dialysis treatment time and frequency into the model. According to the results, the TACs were strongly dependent on the total dialysis time per week (T) value and to a slightly lesser degree on the dialysis frequency per week (N) value for both solutes. It is concluded that the 1-compartment model introduced in this study is valid for estimating the TACs of BUN and β2-MG in patients undergoing maintenance HD therapy, and T and N values are important factors influencing the adequacy of solute removal in patients receiving maintenance HD therapy.

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