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Comparison of Dual Dialyzers in Parallel and Series to Improve Urea Clearance in Large Hemodialysis Patients
Author(s) -
Fritz B.,
Doss S.,
McCann L.,
Wrone E
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01211.x
Subject(s) - medicine , hemodialysis , kt/v , dialysis , urea , dual purpose , urology , crossover study , surgery , chemistry , mechanical engineering , alternative medicine , organic chemistry , pathology , engineering , placebo
Dialysis adequacy targets are frequently difficult to achieve in large hemodialysis patients. Dual dialyzers can be used to improve clearance. It is unknown whether series or parallel configurations are superior. Objective: to improve urea clearance in large patients using parallel and series dual dialyzers. Patients and Methods: Eighteen large hemodialysis patients (mean 92.4 kg) were enrolled in a randomized, crossover trial to directly compare dual dialyzers in parallel and series configurations. Treatments times, blood flow rates, and dialysate flow rates were kept constant. Results: Compared to single dialyzers, parallel dual dialyzers increased the spKt/V from 1.25 +/− 0.22 to 1.43 +/− 0.29 (p < 0.003). Series dual dialyzers improved the spKt/V to 1.46 +/− 0.26 (p < 0.0003 compared to single dialyzer). The Kt/V and URR of dual dialyzers in parallel were not significantly different from dual dialyzers in series. Half of the subjects failed to meet the NKF‐K/DOQI recommended adequacy target of spKt/V urea >/= 1.2 using a single dialyzer. With the use of dual dialyzers 83% of subjects achieved this adequacy target. Serum levels of ‘middle molecule,’ beta‐2 microgobulin, were reduced 34% after two months of dual dialyzer therapy. Cost analysis estimates annual net savings of $1260 with dual dialyzer therapy, primarily from projected savings in inpatient expenses. Conclusions: In large hemodialysis patients, our study demonstrates that dual dialyzers in parallel and series are equally effective in improving urea clearance without prolonging dialysis treatment times.