Background: Adequacy of delivered dialysis is important in preventing morbidity in patients on hemodialysis for end-stage renal disease. A satisfactory KT/V is often difficult to obtain in patients with a large body mass despite optimization of remediable factors.
Aim: This pilot study was performed to examine the hypothesis that twin dialyzers in parallel enhance delivered KT/V.
Methods: Three compliant patients on maintenance hemodialysis with post-dialysis weights greater than 95 kg who had a KT/V between 1.0 and 1.3 despite optimization of duration of dialysis, blood flow rates and anticoagulation and absence of access recirculation were studied using twin dialyzers in parallel after in vitro experiments demonstrated the safety of this technique. After a run-in period lasting over six months, during which the technique was perfected, three study treatments with twin dialyzers were compared to three treatments before and three treatments after study treatments. Both study and control treatments were performed under identical, rigidly standardized conditions. There was a wash-out period before the control and the study treatments. KT/V was calculated using the post-dialysis blood urea nitrogen (BUN) obtained by the stop-flow technique.
Results: KT/V was higher with twin dialyzers in parallel than with single dialyzers (mean +/- SD 1.54 +/- 0.32 for twin dialyzers vs 1.33 +/- 0.11 for single dialyzers) despite the lack of significant differences in potentially confounding variables.
Conclusions: Using twin dialyzers in parallel appears to enhance delivered KT/V and is a safe and potentially useful technique especially in patients with a large body mass.