Background: Non-adherence to comprehensive management of chronic kidney disease (CKD) especially renal diet and fluid restrictions will hinder the effective management of the overall dialysis population. Long-term effects of indulging and overloading on food and drinks which are not suitable for the dialysis patient brings on a lifetime of suffering from a multitude of diseases such as cardiovascular and bone disease which eventually leads to death. The aim of this research project is to identify the dialysis regime, renal diet and fluid restriction among dialysis patients. Methods: This research is a quantitative descriptive cross-sectional design. The sample was distributed using convenience sampling method with inclusion and exclusion criteria. 80 participants were recruited. The study tool was adopted from Standard for Private Hemodialysis Centre from the Malaysian Ministry of Health for Private Dialysis Centers. Results: Of the 80 participants, most were female (62.5%) and aged 18–25 years (41.3%). Although almost all (98.8%) adhered to the prescribed thrice-weekly hemodialysis (HD) schedule, a notable proportion skipped sessions (31.3%) or ended treatments early (67.5%). Mean adherence scores indicated moderate compliance for fluid (4.123 ± 1.524) and diet (3.988 ± 1.563) management, and low compliance for the dialysis regime (1.44 ± 0.524). Overall, 38.75% had poor, 60% moderate, and only 1.75% good adherence, with no significant association between demographic variables and compliance, highlighting the need for targeted behavioural and educational interventions. Conclusion: Adherence to dialysis, fluid, and diet regimes was generally moderate to low, underscoring the urgent need for patient-centred education and behavioural interventions to improve compliance regardless of demographic background.

Lipopolysaccharide (LPS), also known as an endotoxin, poses serious health risks, such as sepsis, shock, and fever. Detecting LPS is important for hemodiafiltration therapy. In this study, an electrochemical LPS sensor with carbon nanotubes (CNTs) and polymyxin B (PmB) was developed for the first time. Layer-by-layer fabrication was done using dispersed CNTs and a PmB solution. LPS selectively bound to sensing elements and hindered redox reaction of markers, causing the peak current to decrease. As the LPS concentration increased, the number of LPS molecules bound to sensing elements increased, and fewer markers could approach the electrode surface. Consequently, the peak current decreased with increasing LPS concentration. The CNTs contribute to enhance the electrochemical current due to marker ion because of theirs high conductivity and catalytic ability. PmB discriminates LPS, and the CNTs enhance the signal arising from this response. The measurement range was 10fg/mL-10ng/mL. This sensor did not respond to other chemicals, such as human serum albumin, glucose, and bicarbonate, present in biological samples. This performance makes it suitable for water quality management of dialysis fluids, helping reduce the workload of clinical engineers. The CNT-based platform can be expanded to detect other targets and has the potential for widespread application in various areas.

Obturator hernia, a rare condition that accounts for only 0.07-1% of all hernias, typically occurs in older adult, thin, multiparous women owing to weakening of the obturator membrane and increased intra-abdominal pressure. Conditions such as chronic constipation, chronic obstructive pulmonary disease, ascites, peritoneal dialysis (PD), and autosomal dominant polycystic kidney disease (ADPKD) are considered risk factors for an obturator hernia. Diagnosis is often delayed because of nonspecific symptoms, and computed tomography imaging is essential for early detection. We report the case of a 69-year-old woman with ADPKD undergoing PD who developed a right-sided obturator hernia, followed by contralateral recurrences within 3 months. The initial and recurrent hernias were managed with open surgical repair using simple suture techniques. The patient's enlarged kidneys and liver, combined with dialysate fluid, may have contributed to sustained elevated intra-abdominal pressure, increasing the risk for hernia recurrence. This case highlights the unique combination of ADPKD and PD as potential contributors to obturator hernia recurrence.

Despite significant advancements in kidney replacement therapies (KRTs) over the last decades, hemodialysis (HD) continues to consume vast amounts of water and energy. With increasing global water scarcity, it is crucial to take proactive steps to reduce water consumption in this field. Saudi Arabia is one of the world’s driest countries, making sustainable healthcare practice particularly relevant. Many nations have already implemented a green nephrology program to address environmental challenges. Ultrapure dialysis fluids have been recommended as a new standard for contemporary KRT by the international societies of nephrology. Producing ultrapure water requires a water treatment system utilizing reverse osmosis (RO). Water consumption in dialysis, particularly in HD, is a major concern due to the large water volumes required. The exact amount of water consumption in dialysis is variable and depends on several factors. This review discusses multiple strategies to optimize water consumption in HD, including improving RO performance, managing water temperature and quality standards, calculating treatment-related consumption, and designing efficient water treatment systems for dialysis clinics. By examining the key factors influencing dialysis water usage, we aim to contribute to the development of more sustainable and efficient dialysis practices.

The pathophysiology of hypervolemia in chronic kidney disease involves multiple mechanisms, with arginine vasopressin (AVP) playing a key role. Copeptin, a molecule located at the C-terminus of AVP, is often used as a substitute for AVP in clinical studies. In this study, we aimed to determine copeptin levels in pediatric patients with kidney failure treated by peritoneal dialysis (PD) and evaluate any possible correlation between bioimpedance parameters (BIA) and peritoneal transport parameters obtained from the peritoneal equalization test (PET). The study included 37 patients undergoing PD as the patient group and 37 healthy children of the same gender and similar age as the control group. Patients' serum and peritoneal dialysis fluid copeptin levels and PET and BIA parameters were evaluated simultaneously, and possible relationships between them were examined. Serum copeptin levels in the patient group were found to be significantly higher than those in the control group (7.31ng/ml vs. 2.55ng/ml, p < 0.001). A negative correlation was observed between serum copeptin levels and age distribution in the control group. No relationship was found between serum copeptin levels and age or gender in the patient group. Furthermore, no significant correlation was found between serum copeptin levels and clearance values as well as transport parameters obtained by PET parameters and BIA parameters. Serum copeptin levels are higher in patients on PD compared to the control group. However, no significant relationship is found between serum copeptin level and BIA or PET parameters. Further studies are needed to understand more about this subject.

Patient: Female, 41-year-oldFinal Diagnosis: Pregnant with CKD-G4Symptoms: NoneClinical Procedure: —Specialty: NephrologyObjective: Unusual clinical courseBackgroundPregnancy in patients with advanced chronic kidney disease (CKD) carries a high risk of complications, including preterm birth, the need for dialysis, and adverse maternal-fetal outcomes. Miscarriage is also relatively common in dialysis patients. However, there are no established guidelines regarding dialysis initiation or fluid management in pregnant women with renal failure.Case ReportA 41-year-old Japanese woman had been diagnosed with IgA nephropathy at age 17 following abnormal urinalysis, but subsequently discontinued medical follow-up. Later, she became pregnant and was diagnosed with CKD stage G4 at 6 weeks of gestation (estimated glomerular filtration rate: 28.2 mL/min/1.73 m2). Despite being informed of her high-risk status, she strongly wished to continue the pregnancy. Management included salt restriction, antihypertensive therapy, and close monitoring. At 31 weeks, worsening renal function and hypertension prompted the initiation of hemodialysis. Body fluid status was assessed using bioelectrical impedance analysis and the amniotic fluid index. Dialysis parameters were adjusted to avoid fetal compromise. Vaginal delivery occurred at 36 weeks. Hemodialysis was discontinued on postpartum day 6 following improvement in renal function, and both mother and infant were discharged without complications.ConclusionsThis case illustrates that individualized fluid control and close inpatient monitoring can enable both the continuation of pregnancy and successful dialysis withdrawal in patients with advanced CKD. Body composition monitoring may serve as a useful tool for managing fluid balance during pregnancy-related dialysis. This report contributes to the limited literature on dynamic dialysis decision-making in pregnant CKD patients.

BackgroundGlucose and insulin blood levels are well known altering factors for 18F-fluoro-2-deoxy-2-d-glucose positron emission tomography-computed tomography ([18F]-FDG PET-CT) interpretability in peritoneal dialysis (PD) patients. A potential influence of glucose-based solutions and Icodextrin in PD patients has not been studied. The aim of this study was to assess PET-CT interpretability in PD patients according to the osmotic agent used in the dialysis fluid (Icodextrin vs. glucose) and the timing of dialysate infusion before imaging.MethodsWe searched for all PET-CT performed on individuals receiving PD between January 2020 and March 2024 at Cliniques universitaires Saint-Luc, Brussels, Belgium. Peritoneal membrane characteristics, data regarding dialysis solutions, PET-CT parameters and results were collected. We analyzed available data regarding insulinemia and glycemia during a PD exchange.ResultsFourteen PET-CTs were available for study of which four were performed on PD patients with a glucose-based solution dwell at imaging, six with Icodextrin, and three with an empty abdomen. Data regarding the presence or absence of PD fluid was missing for one patient. The only uninterpretable exam was performed on a patient injected with [18F]-FDG 86 min after an exchange with a glucose-based solution. All other exams in the glucose-based group were interpretable with a mean PD fluid infusion to [18F]-FDG injection time of 186 min. All PET-CTs in patients with an Icodextrin dwell were interpretable.ConclusionIn this small PD cohort, PET-CT interpretability appears preserved with Icodextrin dwells and may be adequate with glucose-based solutions if sufficient time elapses, requiring confirmation in larger studies.

Hemodialysis, the principal therapy for end-stage renal disease (ESRD), directly influences pulmonary mechanics by alleviation of fluid overload and uremic toxin accumulation. Hemodialysis (HD), the main renal replacement therapy, removes excess volume and solutes, but its acute effects on pulmonary function remain uncertain. This meta-analysis evaluates impact of hemodialysis on pulmonary function and examines pre-to post-dialysis changes in spirometric parameters among ESRD patients. We conducted meta-analysis of cross-sectional studies that measured pulmonary function in ESRD patients on maintenance hemodialysis. Data from 16 eligible studies (n = 719 patients) were synthesized. Our analysis was focused on changes in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, forced expiratory flow at 25%-75% (FEF25-75), and peak expiratory flow rate (PEFR). Statistical analysis was performed using random-effects models to calculate pooled mean differences (MD) for spirometric outcomes. Hemodialysis was associated with significant improvements in percent-predicted FEV1 (+8.99%) and FVC(+12.87%), while absolute changes in these parameters were small and not statistically significant. The FEV1/FVC ratio and PEFR also improved in percent-predicted terms. Sensitivity analyses confirmed stability of results, though high heterogeneity (I2>75%) was observed for several outcomes. Publication bias was minimal, with Egger's and Begg's tests indicating no significant asymmetry, except for borderline Begg's p-value for FVC (%pred). These improvements likely reflect ultrafiltration-mediated relief of pulmonary congestion and modulation of uremic milieu. Hemodialysis acutely mitigates renal failure-related pulmonary restriction, with percent-predicted spirometry showing consistent gains. These effects highlight role of dialysis prescriptions and fluid management strategies in optimizing respiratory as well as renal outcomes.

Patients with ESRD who receive dialysis experience a wide range of unpleasant symptoms that have a negative effect on patient prognosis. The aim of this study was to evaluate the relationship between dialysis symptoms, adherence to interdialytic weight gain, fluid control, and associated factors in hemodialysis patients. This study was conducted in a descriptive and cross-sectional design. Demographic and clinical characteristics form, mean of interdialytic weight gain last 12 hemodialysis sessions, Fluid Control in Hemodialysis Patients Scale, and Dialysis Symptom Index (DSI) were used to collect data. Patients with chronic illnesses and unemployment patients experienced higher DSI scores. The literate participants had a significantly higher DSI and lower adequacy of fluid intake. The regression analysis results showed that employment, chronic diseases, dialysis adequacy, and compliance with fluid intake explained 20.3% of the variance and that the model was a significant predictor of the DSI. Dialysis symptoms were seen prevalently among the patients, and factors such as employment status, chronic disease, dialysis adequacy, and fluid intake compliance affected the DSI. It is important to monitor the fluid volume status and hemodialysis symptoms of hemodialysis patients regularly.

altered taste perception, appetite loss, and dietary non-compliance are common complications in hemodialysis patients (HD) that contribute to protein-energy wasting (PEW) and poor nutritional status. this study investigated the relationships between altered taste perception (altTP), appetite status, and nutritional parameters in HD patients, particularly in relation to PEW, based on the Malnutrition Inflammation Score (MIS). a total of 70 HD patients were included. PEW was classified using MIS. Taste perception was evaluated subjectively, appetite was measured using the Appetite and Diet Assessment Tool (ADAT), and fluid/dietary compliance was assessed with the Dialysis Diet and Fluid Non-adherence Questionnaire (DDFQ). Anthropometric data, dietary intake, and biochemical markers were recorded. according to MIS, 31.4 % of patients were classified as PEW. Patients reporting altered taste, especially those perceiving a metallic taste, had significantly higher MIS scores and dietary sodium intake, while showing lower dry weight and total iron-binding capacity (TIBC) (p < 0.05). A significant positive correlation was found between zinc and albumin levels (r = 0.422, p = 0.001). Logistic regression analysis showed that, changes in appetite and non-adherence to diet were positively associated with MIS, while MUAC, serum albumin, TIBC, and daily energy intake were negatively associated. the findings underscore the clinical importance of altered taste, particularly metallic taste, and appetite loss as indicators of nutritional risk in HD patients. These sensory changes are strongly associated with key markers of PEW, suggesting the need for early identification and nutritional intervention in this population.

Peritoneal fibrosis (PF) is a major complication of long-term peritoneal dialysis (PD). This study investigated the protective effects and mechanisms of asiaticoside (AC) against PF. In vitro, HMrSV5 cells were exposed to peritoneal dialysis fluid (PDF) with or without AC, and assessed for viability, migration, fibrosis/mesothelial-to-mesenchymal transition (MMT) markers (α-smooth muscle actin (α-SMA), Collagen I, E-cadherin, Vimentin), reactive oxygen species (ROS), mitochondrial membrane potential, and aryl hydrocarbon receptor (AhR) transcriptional activity using a dual-luciferase reporter assay. Subcellular localization of AhR was evaluated to examine nuclear translocation, and AhR overexpression was employed to confirm pathway dependence and its interaction with nuclear factor erythroid 2 related factor 2 (Nrf2). In vivo, mice received daily intraperitoneal 4.25% PDF with or without oral AC (50 or 100mg/kg), and peritoneal function, histology, and α-SMA/Collagen I expression were quantified. AC co-treatment significantly inhibited PDF-induced MMT, oxidative stress, mitochondrial dysfunction, and AhR nuclear translocation, while enhancing Nrf2 nuclear accumulation; AhR overexpression partially reversed these effects. In mice, AC preserved peritoneal function, reduced fibrosis, and modulated AhR-Nrf2 signaling. These results demonstrate that AC protects against PDF-induced PF by suppressing AhR activation and promoting Nrf2 nuclear translocation, indicating its protective effects in preclinical models of PD-associated PF.

Peritoneal dialysis is a therapeutic option for end-stage kidney disease patients that offers a better quality of life Peritoneal dialysis is a treatment option for patients with stage V chronic kidney disease that offers a better quality of life compared to hemodialysis. Abdominal wall hernias and scrotal edema are potential complications of peritoneal dialysis that may require discontinuation of the technique. However, radiological diagnosis and treatment of the hernia allow peritoneal dialysis to be resumed. We report here the case of a 72-year-old patient presenting with unilateral recurrence of an inguinal hernia with scrotal edema after bilateral open repair due to leakage of peritoneal dialysis fluid through a patent processus vaginalis, and we reviewed the existing literature. The literature reports that 4 to 14% of peritoneal dialysis patients develop an abdominal hernia and that dialysate leakage or scrotal edema, which are rarer, are often associated with an indirect inguinal hernia or a persistent patent processus vaginalis. Several risk factors have been identified: age, male gender, obesity, polycystic kidney disease, history of hernia, and high dialysate volumes. The diagnosis is based mainly on peritoneal computed tomography. Management may be conservative, but surgical repair using a tension-free technique, preferably according to Lichtenstein, is recommended in cases of confirmed primary or recurrent hernia. The optimal time to resume peritoneal dialysis remains variable, but is most often between 2 and 6 weeks.

BackgroundPeritoneal fibrosis represents a major clinical challenge for end-stage renal disease (ESRD) patients when they are undergoing peritoneal dialysis (PD). Single-cell RNA sequencing identified that peritoneal mesothelial cells undergo a senescence fate transition in long-term PD patients. Whereas the existence of mesothelial cell senescence and the underlying mechanisms should be thoroughly explored.MethodsTo further investigate mesothelial cell senescence, we utilized a clinical cohort comprising dialysate effluents from PD patients and peritoneal biopsy specimens, peritoneal dialysis fluid (PDF)-induced mouse models, and cultured primary mesothelial cells. Single-cell RNA sequencing, transcriptome sequencing, immunofluorescence, Western blotting, and other analyses were administered. To validate the critical role of β-catenin in mesothelial cell senescence, β-catenin knockout mice were employed. Additionally, the senolytic drugs dasatinib plus quercetin were administered to PDF mice to assess the key role of mesothelial cell senescence in peritoneal fibrosis.ResultsSingle-cell RNA sequencing demonstrated that mesothelial cells derived from long-term PD patients are major trend to senescence fate. Moreover, β-catenin signaling was significantly upregulated, as well as transforming growth factor-β (TGF-β) pathways. We observed that senescent mesothelial cells were highly increased in both dialysate effluent and peritoneal biopsies of long-term PD patients. In dialysate effluent, matrix metalloproteinase-7 (MMP-7), an indicator of downstream targets of β-catenin, was positively correlated with TGF-β1. Both biomarkers were also positively associated with PD duration. Mechanistically, we found that β-catenin promotes dynamin-related protein 1 (Drp1) expression, a key mediator of mitochondrial fission, thereby inducing mesothelial cell senescence. Then, TGF-β1 was secreted to activate the Smad signaling pathway in fibroblasts, leading to myofibroblast activation and subsequent peritoneal fibrosis. Notably, administration of senolytic drugs, dasatinib plus quercetin, significantly alleviated peritoneal fibrosis regardless of treatment timing.ConclusionTargeting β-catenin signaling and mesothelial cell senescence may represent potential therapeutic interventions for preventing peritoneal fibrosis.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40779-025-00669-1.

Macrophage extracellular traps promote peritoneal fibrosis through the ROS/TGF-β/Smad pathway under high-glucose dialysis conditions.

Reverse Osmosis water is a major component in the hemodialysis process, acting as a solvent for dialysate fluid. The microbiological quality of Reverse Osmosis water significantly impacts patient safety, particularly with regard to endotoxin contamination originating from the cell walls of Gram-negative bacteria. This 2025 study aimed to analyze the relationship between total plate count (ALT) and endotoxin levels in Reverse Osmosis water in the hemodialysis unit of Hospital X, Mojokerto City. This study used an analytical observational design with a cross-sectional approach. Samples were obtained from a single location, namely water produced by the Reverse Osmosis machine that was ready to be flowed into the hemodialysis machine. Sampling was carried out 20 times, 10 samples of Total Plate Count and 10 samples of Endotoxin for five consecutive days at two different times each day, namely the morning shift (around 08.00–10.00) and the afternoon shift (around 13.00–15.00). ALT was examined using the pour plate method, and endotoxin levels were measured with the Nexgen device using the chromogenic LAL method. Based on the Spearman test results, a correlation coefficient (r) value of -0.518 was obtained with a significance value (p) of 0.125 (p &gt; 0.05), which indicates that there is a moderate negative relationship between ALT and endotoxin levels, but this relationship is not statistically significant at the 95% confidence level (α = 0.05). Therefore, in this study, changes in the Total Plate Count (ALT) did not affect the amount of endotoxin.

Background: Glucose, a central carbohydrate in higher organisms’ metabolism, can undergo extensive oxidative modification under conditions of excessive inflammation or elevated reactive oxygen and nitrogen species (RONS). Such modifications yield glucose oxidation products (GOPs) with potential biological relevance and toxicity. This study aimed to systematically characterize GOP formation under defined oxidative conditions generated by gas plasma treatment. Methods: D-glucose solutions were prepared at 0.25 mM (hypoglycemic/diabetic range), 2.5 mM (sub-physiological), and 25 mM (peritoneal dialysis fluid). Samples were exposed for up to 20 min to the atmospheric-pressure argon plasma jet kINPen, which produces a wide spectrum of RONS. Treatment time-dependent glucose oxidation was assessed by high-resolution mass spectrometry (HRMS) and tandem mass spectrometry (MS/MS) to identify the oxidation products. Results: Gas plasma exposure generated various oxidation products and their abundance profiles depended on initial glucose concentration and treatment duration. Identified products included 2-keto-D-glucose, 3-deoxyglucosone (3DG), 3,4-dideoxyglucosone-3-ene (3,4DGE), furaldehyde, methylglyoxal, and acetaldehyde. HRMS/MS analysis confirmed diagnostic fragment ions for each GOP and revealed distinct formation across the model scenarios. Conclusions: Cold gas plasma induces a spectrum of glucose oxidation products under biomedically relevant glucose levels. The identified GOPs, many of which have known cytotoxic or signaling properties, provide mechanistic insight into glucose oxidation in inflamed or oxidative microenvironments. These findings support the utility of plasma-based oxidative models for studying GOP-associated biological effects and potential pathophysiological consequences.

Peritoneal dialysis catheter malfunction compromises dialysis adequacy. Standard imaging methods in the case of peritoneal catheter malfunction include abdominal X-ray, fluoroscopic catheter peritoneography, and computed tomography. Ultrasound has only recently been utilized to evaluate the intraperitoneal part of the catheter. In clinical routine, catheter function is assessed by the time needed to fill or drain a defined quantity of peritoneal dialysis fluid. Visual functional testing of the catheter can be performed by fluoroscopy or by contrast-enhanced ultrasound. We developed and tested a color Doppler ultrasound technique for dynamic imaging of the peritoneal catheter based on signal generation by dialysis fluid flow. The feasibility of the color Doppler approach was evaluated utilizing a phantom. Furthermore, the technique was applied in 28 peritoneal dialysis patients, most of whom presented peritoneal catheter malfunction. Color Doppler examination improved the cathetervisualization, especially in cases in which the catheter is embedded between the intestinal loops. Furthermore, this technique highlightedcatheter side holeocclusionsbyadhesions or intraluminal thrombi. The examination can be performed either during filling or draining of dialysis fluid. The color Doppler ultrasound technique appears to be helpful inidentifying problem-solving strategies in malfunctioning peritoneal catheters.

Hospital-based health technology assessment of central dialysis fluid delivery system for hemodialysis patients

Severe hypercapnia, especially when associated with acidosis, should be avoided or actively managed, as it is an independent risk factor in critically ill patients. The ADVOS multi hemodialysis system offers the potential to correct acidosis and hypercapnia through customizable pH and bicarbonate content within the dialysate fluid. The aim of this work is to analyze the exact timing for pH correction and the main factors leading to it in patients with multiple organ failure (MOF) and hypercapnic acidosis treated with ADVOS. Patients with MOF and metabolic or hypercapnic acidosis (pH < 7.35) were included over a study period of 13months. All patients received at least one treatment with ADVOS hemodialysis system for at least 24h. The primary outcome was the time to blood pH ≥ 7.35. 24 patients with a median age of 61years and a median SOFA score of 15 points were included. The results of 134 ADVOS sessions, with a median of 5 sessions per patient, were analyzed. Median time to blood pH ≥ 7.35 was 4h; a significant blood pH increase within 24h was reached in all patients (7.21 before vs. 7.39 after, p < 0.01). A single session of ADVOS corrected blood pH and supported the reduction of pCO2 with a median CO2 removal of 55mL/min in patients with multiple organ failure and hypercapnic acidosis.

Abstract Background Environmental changes, such as global warming and abnormal climate changes, have become a major global issue. In this study, we focused on reducing the total dialysate flow rate ( Q D_total ) during online hemodiafiltration as an immediately implementable and feasible countermeasure. Accordingly, this study was aimed at investigating the impact of post-dilution online HDF (post-HDF) at Q D_total = 350 mL/min on the solute removal performance and at considering treatment conditions that would minimize excessive albumin leakage when using high-performance membrane hemodiafilters. Methods On the basis of data on the treatment conditions and solute removal characteristics obtained when patients were switched from predilution online HDF (pre-HDF) at Q D_total = 500 mL/min to post-dilution online HDF (post-HDF) at Q D_total = 400 mL/min, the authors examined the appropriate substitution fluid volume to be used. The solute removal performances of post-HDF at Q D_total values of 400 and 350 mL/min were also compared. Results Switching of the dialysis mode from pre-HDF at Q D_total = 500 mL/min to post-HDF at Q D_total = 400 mL/min was not associated with any reduction in the removal efficiency for small molecule solutes. However, the elimination rate of α 1 -microglobulin, a large-middle molecule, increased when the substitution fluid volume was controlled, but decreased when the convection volume (CV) was controlled. There was no difference in the solute removal performance for small to large-middle molecules between post-HDF at Q D_total = 400 and Q D_total = 350 mL/min. Conclusions With post-HDF performed using hemodiafilters of appropriate pore sizes and control of the filtration volume via the CV, the Q D_total could be reduced to 350 mL/min while maintaining efficient removal of small to large molecules. Reduction of water consumption is one of the most immediate countermeasures to combat environmental issues and reducing dialysis fluid consumption is a simple and feasible method to reduce water consumption.