A pilot study of twin dialyzers in parallel to enhance delivered KT/V

Background: Adequacy of delivered dialysis is important in preventing morbi dity in patients on hemodialysis for end-stage renal disease. A satisfactor y KT/V is often difficult to obtain in patients with a large body mass desp ite optimization of remediable factors. Aim: This pilot study was performed to examine the hypothesis that twin dialyzers in parallel enhance delivere d KT/V. Methods: Three compliant patients on maintenance hemodialysis with post-dialysis weights greater than 95 kg who had a KT/V between 1.0 and 1.3 despite optimization of duration of dialysis, blood flow rates and anticoa gulation and absence of access recirculation were studied using twin dialyz ers in parallel after in vitro experiments demonstrated the safety of this technique. After a run-in period lasting over six months, during which the technique was perfected, three study treatments with twin dialyzers were co mpared to three treatments before and three treatments after study treatmen ts. Both study and control treatments were performed under identical, rigid ly standardized conditions. There was a wash-out period before the control and the study treatments. KT/V was calculated using the post-dialysis blood urea nitrogen (BUN) obtained by the stop-flow technique. Results: KT/V was higher with twin dialyzers in parallel than with single dialyzers (mean +/ - SD 1.54 +/- 0.32 for twin dialyzers vs 1.33 +/- 0.11 for single dialyzers ) despite the lack of significant differences in potentially confounding va riables. Conclusions: Using twin dialyzers in parallel appears to enhance d elivered KT/V and is a safe and potentially useful technique especially in patients with a large body mass.