Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Background
Hemodialysis consumes large volumes of water. Dialysate flow (FD) is typically fixed at 500 mL/min, regardless of the effective blood flow (eQB), which may lead to avoidable waste. Adjusting dialysate flow (ADF) in proportion to eQB is a potential strategy to improve water efficiency. We assessed the impact of implementing a standardized ADF protocol on water consumption, dialysis adequacy, and clinic-level hyperkalemia in Brazil.
Methods
This retrospective cohort included 32 clinics operated by a single organization that used machines with automated ADF in proportion to the eQB and had complete water consumption data. Clinics with significant disruptions that could have impacted water use were excluded. ADF at a fixed ratio of 1.2×eQB was formally implemented in September 2024. Data from Q4 2023 (pre-implementation) and Q4 2024 (post-implementation) were compared. Outcomes included total and per-session water consumption, Kt/V, and the proportion of patients with serum potassium >5.5 mEq/L. Comparisons were performed using the Wilcoxon signed-rank test for paired samples. Analyses were conducted using JAMOVI (v2.4).
Results
Across 486,592 sessions (229,812 in Q4 2023 and 256,780 in Q4 2024), total water consumption decreased by 14,453 m3. Median water consumption per session dropped from 381 L to 330 L, despite an increase in the proportion of patients on hemodiafiltration - which would typically be expected to raise water usage. Dialysis adequacy remained stable (median Kt/V: 1.63 vs. 1.65, p=0.333), as did the proportion of patients with K >5.5 mEq/L (33% vs. 32%, p=0.510).
Conclusion
The adoption of an ADF-based protocol was associated with a clinically meaningful reduction in water consumption per dialysis session, without compromising dialysis adequacy or potassium control. These findings support dialysate flow optimization as a feasible approach to enhance environmental sustainability in HD programs.
