Abstract
BACKGROUND: Blood flow rate (BFR) and time of dialysis are important determinants of dialysis adequacy. This study aimed to determine the impact of higher BFR and longer dialysis time on nutritional status in chronic hemodialysis (HD) patients. 
 
 METHODS: Real-world evidence (RWE) studies of 3 HD units in different hospitals that differ in BFR and/or dialysis time. Group I, HD 5 hr and BFR 200-250 mL/min; group II, HD 4 hr and BFR 270-320 mL/min, and group III, HD 4 hr and BFR 200-250 mL/min. All HD units use the same dialysate flow and dialysis frequency. Nutritional status was assessed using a 3-point scale Subjective Global Assessment. 
 
 RESULTS: A total of 233 chronic HD patients were included, mean of age was 52 ± 12.9 years, 46.5% were male. There are 69.5% on SGA class A, 27.5% on SGA class B, and 3% on SGA class C. The proportion of SGA class A in group II was highest compared to group II and III (93.5% vs 79.0% vs 32.1% (p <0.05). There was no SGA class C in group II, whereas 2.4% in group I and 7.4% in group III. In group II there was lower interdialytic weight gain (IDWG) and less use of anti-hypertensive drugs compared to group III (p <0.05). 
 
 CONCLUSION: Our study showed that higher BFR and longer dialysis time are associated with better nutritional status in chronic HD patients. A higher BFR seems to have a more substantial impact compared to a longer dialysis time.
 
 Keywords: blood flow rate, dialysis time, subjective global assessment, nutritional status
Highlights
Dialysis adequacy reflects the efficacy of hemodialysis (HD) treatment and correlates well with nutritional status (Nunes et al, 2008)
Our study showed that higher Blood flow rate (BFR) and longer dialysis time are associated with better nutritional status in chronic HD patients
Our results show that BFR 270-320 ml/min with the same membrane, dialysate flow, dialysis time, and dialysis machine is associated with better nutritional status compared to BFR 200-250 ml/min
Summary
Dialysis adequacy reflects the efficacy of hemodialysis (HD) treatment and correlates well with nutritional status (Nunes et al, 2008). Many factors are associated with an increase in urea clearance and possibly dialysis adequacy, namely blood flow rate (BFR) (Borzou et al, 2009; Hassel, Van der Sande, Kooman, Tordoir, & Leunissen, 2001), dialyzer KoA (Mandolfo, Malberti, Imbasciati, Cogliati, & Gauly, 2003), dialysis time, dialysis frequency (Locatelli et al, 2005), dialysate flow (Hauk, Kuhlmann, Riegel, & Kohler, 2000), and needle size (Mehta, Deabreu, McDougall, & Goldstein, 2002). Increasing duration of dialysis is a useful method for increasing Kt/V, but it is not always possible because of economic factors and intolerance of patient. Blood flow rate (BFR) and time of dialysis are important determinants of dialysis adequacy. This study aimed to determine the impact of higher BFR and longer dialysis time on nutritional status in chronic hemodialysis (HD) patients
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