Dialysis Adequacy on Tablo Hemodialysis Machines Related to Patient Weight

Background: Tablo Hemodialysis (HD) machines are newer machines with maximum dialysate flow rate of 300ml/min. Therefore we conducted an IRB approved study to evaluate whether adequate dialysis clearance is obtained with the dialysate flow rate of 300ml/min. Methods: Hemodynamically stable end stage renal disease patients with age over 18 years receiving routine dialysis during hospitalization were included. Patients with acute kidney injury or hemodynamic instability were excluded. Serum blood urea nitrogen lab was drawn at the beginning and end of dialysis and this was performed once for each patient. Based on the urea reduction ratio (URR), the treating provider would change the patient’s dialysis prescription for future adequacy. Primary outcome was to reach URR > 65% and spKt/v >1.2. Results: Patients that weighed less than 80kg had a mean URR > 65% and spKt/V> 1.2 and were able to achieve primary outcome (figure 1). However, patients that weighed more than 80kg were unable to reach primary outcome. Then a larger dialyzer, Optiflux F250NR, was used on patients that weighed more than 80kg and 9 out of the 12 patients were able to achieve adequate clearance (figure 2). Conclusion: Tablo HD machine has reduced clearance with higher patient weights. Larger dialyzers, increased time or frequency of dialysis should be considered. Limitations include that the 12 treatments with Optiflux F250NR wasn't enough for statistical significance but most patients achieved clearance.