Auto Flow Feature Reduces Dialysate Use While Maintaining Dialysis Adequacy Among In-Center Hemodialysis (HD) Patients

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Background: Adjustment of dialysate flow rate (Qd) as a proportion of blood flow rate (Qb) may lower dialysate consumption. The Auto Flow (AF) feature on Fresenius Medical Care 2008T dialysis machines can make these adjustments automatically. Using real-world data, we investigated the use of the AF feature and its impact on dialysis adequacy among in-center HD patients. Methods: Adult in-center HD patients converting from manual to AF (either 1.5 or 2.0 times the Qb) during 2021 at Renal Research Institute clinics were included. All patients had Kt/V measured 3 months before and after switching to AF and no change in vascular access, dialyzer types or prescribed Qb. Parameters were averaged over each 3-month period before and after switch, and comparisons between time periods were made using paired t-tests. Results: At AF switch, patients (n=48) had mean age of 64 years and vintage of 7 years. Most patients had a fistula (63%) and used Optiflux 180NRe (85%). 46% and 54% patients were switched to AF 1.5 and AF 2.0, respectively. After switch, on average, actual Qd reduced by 37 mL/min; based on the treatment time and actual Qd, we calculated that 8.6 L dialysate volume could be saved per patient per treatment (p<.0001). There was no statistically significant change in mean spKt/V, although there was a numeric increase after switch (table). Sub-analysis by AF 1.5 and 2.0, showed no change in spKt/V among patients switched to AF 1.5 (1.67) and an increase from 1.55 to 1.61 (p=0.06) among those switched to AF 2.0. Conclusions: Use of the Auto Flow feature during HD maintained patients' dialysis adequacy. Based upon actual Qd and treatment time, we can estimate that this would save, on average, 8.6 L of dialysate per patient per treatment (p<0.0001). Funding: Commercial Support - Fresenius Medical Care

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