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A study of 8 hour long night dialysis with the Aksys PHD dialysis system
Author(s) -
Kjellstrand C.,
Blagg C.R.,
Ing T.S.,
Young B.
Publication year - 2005
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 - 10.1111/j.1492-7535.2005.1121ae.x
Subject(s) - liter , dialysis , medicine , hemodialysis , urea , creatinine , kt/v , extracorporeal , urology , surgery , zoology , chemistry , biochemistry , biology
The Aksys PHD system is designed for short quotidian dialysis employing a 52‐liter batch of ultrapure dialysate and up to 30 in situ hot water reuses of the entire extracorporeal circuit including a 40‐liter physical cleaning before each dialysis. Methods: We studied the effect of the 52‐liter tank during 108 long 5–8 hour dialysis 3.5–6 times/week in 5 patients and one 50‐liter patient simulator for 4 weeks. Phosphate (PO 4 ), beta‐2 microglobulin (b‐2), urea (BUN), and creatinine (creat) were measured pre‐, during, and post‐dialysis 86 times and in total dialysate 74 times during long dialysis. Tank saturation, Kt/V, and monthly chemistries were also measured. Results: Patient weight 76 ± 2 kg, QB 234 ± 23 ml/min, QD 498 ± 13 ml/min. Dialysate was recirculated 4.8 times during 8 hours.Analyte Short Long dialysis pPre‐BUN 70 ± 18 49 ± 15 <0.0001 Pre‐creat 12 ± 3 10 ± 2 <0.0002 Pre‐PO 4 5.2 ± 1.5 4.1 ± 1.1 <0.003 Pre‐b‐2 34.0 ± 5.3 27.8 ± 4.5 <0.0001All patients on 8 hrs × 5 dialyses/week stopped phosphate binders within 3 weeks. eKt/V(urea) rose to 0.5 in one hour and then slowly to 0.8 at 8 hours.Weekly stdKt/V: Dialyses/week/Hrs: 2 5 85 2.2 2.7 3.0 6 2.7 3.4 3.6 7 3.1 3.8 4.4At 8 hrs the tank was 99 ± 8% saturated with BUN, 86 ± 12% with creat, 77 ± 18% with PO 4 , and only 12 ± 5% with b‐2. Total removal per dialysis increased 2 gm BUN, 0.4 gm creat, 0.4 gm PO 4 , and 40 mg b‐2. The decline per reuse in conductivity clearance was only 0.7 ± 1.2% during short and 1.4 ± 1.4% during long dialysis (p = 0.11). There was no change in monthly chemistries or hematologies.Discussion: The data show that the Aksys PHD is very effective for long 8‐hour dialysis. The data for PO 4 and b‐2 are the same as reported for conventional dialysis machines using 5 times as much dialysate, and the weekly stdKt/V if the PHD is used every night is twice the standard defined by K/DOQI. The exceptional cleanliness and biocompatibility by way of the one‐per‐month reuse should be a great advantage to patients. The full automatization saves the patient one hour every night and 30 minutes every morning. The PHD also economizes on filters and dialysate and is good for the environment.