The usefulness of a single-pass batch dialysate delivery system for home hemodialysis.
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We examined the usefulness of the single-pass batch dialysate delivery system for home hemodialysis (HD). There are 2 methods to prepare dialysate, continuous preparation and pretreatment preparation. We selected pretreatment preparation since it is more economical and produces dialysate with a more stable electrolytic composition than the continuous preparation. Then, we theoretically compared the dialysis efficiency of 2 dialysate circulation methods, the single-pass method and the recirculation method, and the dialysis efficiency was found to be superior in the former method than in the latter. When the blood flow rate (Qb) was 200ml/min and the overall mass transfer-area coefficient of the dialyzer was 600ml/min, the dialysate volume of 60 liters, 3 times week for 240 min HD was necessary to achieve the weekly dialysis dose of KT/V=3.6 for a patient with a urea distribution volume of 30 liters determined by the single-pass method. Based on this preliminary information, we performed the single-pass batch 3 times a week HD with a Qb of 200 and a dialysate flow rate (Qd) of 250ml/min in 2 chronic renal failure patients and compared the dialysis efficiency to that by conventional HD with a Qd of 500ml/min. The dialyzer used was polysulfone with a surface area of 1.6m2. To evaluate the dialysis efficiency, we analyzed the kinetics of urea and creatinine by variable-volume 2-compartment model. Although there were no significant differences between the 2 HD treatments in the time-averaged concentrations of the 2 solutes, the lower Qd resulted in a 10% decrease in the equilibrated KT/V (KT/Ve) of urea (0.943 vs. 0.352, P=0.053) and 5% decrease in the KT/Ve of creatinine (0.709 vs. 0.676, P=0.153). The decrease in KT/Ve of urea was estimated to be compensated by the 30 min added to the treatment time for 240 min HD.It was concluded that the single-pass batch dialysat delivery system with a Qd of 250ml/min is useful for home HD. The batch volume of about 80 liters for the 3 times a week HD was considered appropriate for longer treatment times up to 300 min.
- 社団法人 日本透析医学会の論文
社団法人 日本透析医学会 | 論文
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