Hemodialysis 101 | Focus on Five Details to Effectively Improve Hemodialysis Adequacy

Hemodialysis (HD) is the most common renal replacement therapy for patients with end-stage renal disease (ESRD), with 87% of ESRD patients undergoing this treatment.

According to the 2022 China National Renal Data System (CNRDS), nearly a million (844,000) patients are receiving HD, and the number of new HD patients continues to rise rapidly each year.

Hemodialysis effectively removes metabolic waste from HD patients, preventing discomfort caused by their accumulation. Adequate and standardized dialysis can reduce the incidence of complications in HD patients, prolong survival, and improve prognosis, making it a crucial component of treatment.

There are many factors influencing dialysis adequacy, including patient-related factors and dialysis techniques. Let's delve into how kidney friends can understand the effectiveness of dialysis treatment and methods to improve dialysis adequacy in clinical practice.

Assessing Dialysis Adequacy with Objective Indicators

1. Single-Pool Kt/V (spKt/V) and Urea Reduction Ratio (URR)

In daily treatment, you often hear about Kt/V and URR. These indicators are commonly used by clinical doctors to assess the adequacy of hemodialysis. They are calculated based on pre- and post-dialysis values, reflecting the clearance efficiency of small molecular toxins in the patient's body. A higher value indicates better clearance of small molecular toxins.

The "Clinical Practice Guidelines for Hemodialysis Adequacy in China" recommend patients maintain: spKt/V ≥ 1.2, URR ≥ 65%.

2. Weight Management

Dry weight refers to the weight of kidney friends after dialysis treatment. In treatment, absence of discomfort symptoms, no hypotension after treatment, and overall comfort are signs of an ideal dry weight that kidney friends can tolerate. Dry weight allows doctors to determine appropriate dehydration levels, preventing excess fluid accumulation in the body.

After identifying the appropriate dry weight, HD patients should also pay attention to weight gain between dialysis sessions, which should be controlled within 3% to 5% of dry weight. For example, if the dry weight is 50 kg, the pre-dialysis weight should be controlled between 51.5 to 52.5 kg, calculated at 3% to 5%. For elderly, frail, and diabetic kidney friends, it's best to aim for the lower end of this range.

Methods to Improve Dialysis Adequacy

Develop Three Daily Habits

1. Standardized Dialysis Time

The total weekly dialysis time and frequency are critical factors affecting the metabolism and toxin clearance of patients. Kidney friends must strictly adhere to the prescribed dialysis time by doctors, without shortening or interrupting dialysis arbitrarily, or extending intervals between sessions, to avoid discomfort.

2. Protect Vascular Access

Having a properly functioning vascular access is fundamental to hemodialysis. It is essential for improving the efficacy of hemodialysis treatment, preventing vascular access infections, and enhancing patient prognosis. Patients should develop risk prevention awareness, maintain good communication with healthcare professionals, learn methods to care for vascular access, and prevent negative impacts caused by insufficient blood flow in vascular access.

3. Regular and Moderate Exercise

Common exercise types include aerobic exercise, resistance exercise, and a combination of aerobic and resistance exercises. Studies have shown that exercise interventions can effectively improve dialysis adequacy in HD patients. Combined exercises, which integrate aerobic and resistance training, are more effective in enhancing dialysis adequacy than single exercises.

Opt for Two "Better" Options

1. Choose Superior Dialysis Modes

Common blood purification modes include low-flux dialysis, high-flux dialysis, and hemodiafiltration.

Low-Flux Dialysis (HD) effectively clears small molecular toxins and inflammatory factors, corrects electrolyte imbalances, and removes excess extracellular fluid while preserving important molecules like albumin. However, it struggles with clearing medium to large molecules, potentially leading to various adverse reactions and increased complication rates due to long-term accumulation of medium to large molecular toxins.

High-Flux Hemodialysis (HFHD) features larger membrane pore size and thinner membrane walls, allowing easy passage of various molecules and solutes in the blood. It effectively removes small molecular toxins and filters medium to large molecules, achieving effective removal of inflammatory factors from the blood and improving conditions like microinflammation in patients, with high clinical application value.

Hemodiafiltration (HDF) is a blood purification technique combining diffusion and convection, capable of separately clearing small molecular and medium molecular metabolites. It includes the addition of replacement fluid for ultrafiltration, enhancing the clearance capacity for medium-sized toxins or solutes and helping to reduce complications caused by inadequate removal of medium-sized metabolic toxins in low-flux dialysis.

Different blood dialysis modes have varying treatment effects, but high-flux hemodialysis and hemodiafiltration are preferable. They not only effectively reduce inflammatory reactions in patients but also lower the incidence of complications.

2. Increase Dialysis Blood Flow Rate

Appropriately increasing the pump-controlled blood flow rate (BFR) during dialysis significantly improves dialysis adequacy. Increasing the conventional BFR from 200 mL/min to 300 mL/min can increase clearance rates by more than 15%. It can also reduce the amount of anticoagulant used, lower bleeding complications, promote toxin transport in the blood, and enhance dialysis efficiency.

Studies have found that using higher BFR to optimize dialysis adequacy in patients such as elderly, male, diabetic patients, those using arteriovenous fistulae, and those using low-flux dialysis membranes can significantly improve patient survival benefits. Friendly reminder: Due to differences in symptoms, tolerance, and physical condition among patients, practices should be carried out according to the guidance of doctors, avoiding rushing for results or blindly adjusting.

This issue of popular science has helped many kidney friends recognize the importance of dialysis adequacy and the precautions involved. We believe that kidney friends can face their diseases better and more calmly in the future, ensuring better physical and mental well-being. Let's continue learning about hemodialysis-related knowledge in the next issue!

References:

[1] Wu Yan et al. Comparative Analysis of the Efficacy of High-Flux and Low-Flux Hemodialysis in Treating Diabetic Nephropathy and Their Impact on Patient Inflammatory Reactions and Oxidative Stress. New Diabetes World, 2023, 26(16), 189-193.

[2] Song Xiaoli. Observation of the Efficacy of Different Frequency Hemodialysis in Maintaining Hemodialysis Patients. Famous Doctors, 2023, (13), 57-59.

[3] Luo Xiju et al. Meta-Analysis of the Effect of Exercise during Dialysis on Improving Hemodialysis Adequacy and Solvent Removal Rate. Journal of Nursing Continuing Education, 2023, 38(20), 1890-1896.

[4] Gao Yan et al. Analysis of Influencing Factors of Hemodialysis Adequacy. Journal of Clinical Nephrology, 2020, 20(07), 567-572.

[5] He Juan et al. "Net" Without End, How Do Hemodialysis Patients Keep Healthy? Traditional Chinese Medicine Health Preservation, 2023, 9(03), 67-69.

The above content is for reference only. The platform does not evaluate, endorse, recommend, or guarantee any products and services, nor does it constitute health, diagnostic, or medical advice. The platform does not guarantee the accuracy, scientific validity, or applicability of the content provided by the authors or providers. For any medical conditions, please consult doctors or other professionals.