Slow diurnal hemodialysis for the management of renal failure in critically ill patients

Abstract

Slow hemodialysis (HD) has benefits for treating renal failure in critically ill patients. However, it is difficult to perform this method continuously over 24 hours in general wards. The present study was designed to improve the schedule and system of slow HD. The extra-corporeal circuit was driven by the blood pump at a flow rate of 80ml/min. A non-sterile bicarbonate containing dialysate was passed into the dialyzer at a flow rate of 30ml/min. The treatment was conducted for 10 hours, during the day, in 28 unstable patients with renal failure. Loaded volume was adequately removed during a session of slow HD without developing further hemodynamic instability. The serum urea nitrogen and creatinine concentrations decreased to 50-60% of the pre-treatment levels. The serum β₂-microglobulin level decreased significantly during slow HD using a dialyzer fitted with a high-flux membrane. This approach may allow the performance of efficient renal replacement therapy for unstable patients in general hospitals.