Supplementary Material for: Differential Molecular Modeling Predictions of Mid and Conventional Dialysate Flows

Background: High dialysate flow rates (QD) of 500–800 mL/min are used to maximize urea removal during conventional hemodialysis. There are few data describing hemodialysis with use of mid-rate QD (300 mL/min). Methods: We constructed uremic solute (urea, beta2-microglobulin and phosphate) kinetic models at varying volumes of distribution and blood flow rates to predict solute clearances at QD of 300 and 500 mL/min. Results: Across a range of volumes of distribution a QD of 300 mL/min generally yields a predicted urea spKt/V greater than 1.2 during typical treatment times with a small difference in urea spKt/V between a QD of 300 and 500 mL/min. A larger urea KoA dialyzer and 15 min of additional time narrows the urea spKt/V difference. No substantial differences were observed regarding the kinetics of beta2-microglobulin and phosphate for QD of 300 vs. 500 mL/min. Conclusion: A QD of 300 mL/min can achieve urea clearance targets. Hemodialysis systems using mid-rate QD can be expected to provide adequate hemodialysis, as currently defined.背景：常规血液透析中，通常采用500~800 mL/min的高透析液流量（dialysate flow rate, QD）以最大化尿素清除效率。目前针对采用中等流速QD（300 mL/min）的血液透析的相关数据较为匮乏。 方法：本研究构建了不同分布容积及血流速率下的尿毒症溶质（尿素、β2-微球蛋白（beta2-microglobulin）及磷酸盐）动力学模型，以预测QD分别为300 mL/min与500 mL/min时的溶质清除率。 结果：在一定分布容积范围内，当QD为300 mL/min时，常规治疗时长下预测得到的尿素单池Kt/V（spKt/V）普遍大于1.2，且QD为300 mL/min与500 mL/min时的尿素spKt/V差异较小。使用尿素KoA透析器并延长15分钟治疗时间，可缩小二者的尿素spKt/V差值。对比QD为300 mL/min与500 mL/min的情况，未观察到β2-微球蛋白及磷酸盐的动力学存在显著差异。 结论：QD为300 mL/min可达到尿素清除目标。采用中等流速QD的血液透析系统，可实现当前定义下的充分血液透析。