Improved urea reduction ratio and Kt/V in large hemodialysis patients using two dialyzers in parallel

Delivered dose of hemodialysis (HD) in large patients with end-stage renal disease is often less than adequate. Fourteen chronic HD patients with weig hts greater than 80 kg participated in a prospective, cross-over study comp aring urea reduction ratio (URR +/- SEM) and the fractional clearance index for urea (eKt/V-urea +/- SEM) on a single polysulfone dialyzer for a contr ol (HDC) period of 4 weeks versus clearances obtained with two dialyzers in parallel during an intervention (HDP) period of 4 weeks. Clearance of the surrogate middle molecule iohexol (C-lo) was also measured. Health status w as assessed with the SF-36. Blood and dialysate flow rates and duration of HD sessions were constant. URR increased from 0.67 +/- 0.006 during HDC to 0.72 +/- 0.006 with HDP (P < 0.0001). eKt/V-urea increased from 1.16 +/- 0. 021 to 1.34 +/- 0.021 (P < 0.0001). Increased URR and eKt/V-urea occurred i n all 14 during HDP (P < 0.05). C-lo during HDP averaged 182 +/- 7.7 mL/min compared with 131 +/- 5.4 mL/min in HDC sessions (P < 0.00001), Health sta tus improved in six of eight categories. Expense increased approximately $1 4.27 per dialysis with HDP. In 11 of 14 patients continued on two dialyzers in parallel for 1 year, monthly eKt/V averaged 1.46 +/- 0.066, and health status further improved in five of eight categories. In large patients, two dialyzers in parallel increased urea and iohexol clearance. Increased urea clearance was maintained for 1 year, and health status improved. (C) 2000 by the National Kidney Foundation, Inc.