Abstract
Rapid removal of small molecules during hemodialysis places an acutely ill patient with kidney failure at an increased risk of hemodynamic instability and for dialysis disequilibrium syndrome. The use of high-flux, high-efficiency (HEF) dialyzers may increase this risk despite reductions in blood and dialysate flow. We performed in vitro experiments to compare urea clearance at low dialysate flow and various blood flows using a low-efficiency low-flux (LEF) and a HEF membrane. Compared to LEF, there was a significant increase in the clearance of urea at all blood flows with the HEF (all P values < 0.005). HEF dialyzer (F180NR) had higher urea clearance at a blood flow of 150 mL/min than LEF dialyzer (F5) at blood flow of 300 mL/min (144.1 ± 0.99 vs. 130.1 ± 0.001 mL/min for F180 vs. F5, respectively, P < 0.002). Our data suggest that use of HEF dialyzer are not as safe as LEF in high-risk acute dialysis patients since these are associated with more rapid removal of urea despite reduction in blood and dialysate flow as compared to LEF.
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