Efficacy of slow daily home hemodialysis with internal convection on removal of uremic toxins using the Physidia S3 monitor

Home hemodialysis, despite its recognized clinical benefits such as improved cardiac health and enhanced quality of life, remains underutilized worldwide. This study aims to evaluate the efficacy of home hemodialysis within slow daily dialysis programs, employing the Physidia S3 monitor. A prospective trial was conducted with 16 stable patients suffering from end-stage kidney disease and undergoing home hemodialysis. The study assessed the efficiency of slow daily short treatment dialysis using diverse criteria, including percent reduction, effective clearances, and solute mass removal, across a broad spectrum of uremic compounds, including sodium. Controlled sessions were implemented to replicate daily home treatment conditions. Selecting urea and ß2M as key biomarkers due to their associations with patient outcomes, our study achieved a standardized weekly Kt/V of 2.26 [1.99-2.70] and estimated kidney urea clearance of 11.4 [10.9-12.4] mL/min. ß2M mass removal per session was 146 mg, extrapolating to 707 (×5) and 845 (×6) mg weekly. Additionally, the time-averaged concentration of ß2M was maintained at 19.4 mg/L. The study also identified a net sodium mass removal of 126 mmol [98-182] or 7.4 g [5.8-10.7] NaCl per session. In conclusion, our findings suggest that slow daily, short treatment time, high flux hemodialysis, augmented by enhanced internal convective clearance, represents a highly efficient renal replacement modality on a weekly basis across large molecular weight uremic compounds. Moreover, the solute dialysate saturation coefficient emerges as a promising marker in slow-flow settings.