Can a different priming process of the dialyzer affect dialysis adequacy in chronic hemodialysis patients?

Abstract

In this study, we investigated whether a different priming process of the dialyzer could affect the dialysis adequacy in chronic hemodialysis (HD) patients. 20 HD patients (M/F:12/8) with a median age of 40 (20-74) were included in this study. All the patients were clinically stable and were on bicarbonate-based hemodialysis program 3 times in a week. During the study period of 6 months, we tried to keep the vascular accesses, types and surfaces of the membranes and also the blood and dialysate flow rates almost the same for all patients. For the first 3 months of the study we performed our routine priming process by flushing 1 L of saline from the bloodline without any dialysate passing through the dialyzer. For the next 3 months, we carried out a different priming process. While we passed 1 L of saline through the blood compartment of the dialyzer, we also started the dialysate pump to get a flow rate of 500 mL/min for 30 minutes. After a 3 month period of different priming process, significant increases were observed in Kt/V (1.19±0.14 to 1.35±0.14, p=0.000), URR (%) (62.3±1.1 to 66.9±1.25, p=0.000) and nPCR (1.09t0.04 to 1.25±0.04, p=0.002) parameters. Our findings show that a priming process of the dialyzer by passing both saline and dialysate from the dialyzer for half an hour before starting every dialysis session can improve dialysis adequacy parameters. We suggest that this procedure, by increasing dialysis adequacy, can provide great clinical benefits.