Haemodialysis
The AutoFlow Function for the
5008 Therapy System
Optimising the Dialysis Fluid Flow Rate
The Dialysis Fluid Flow Rate
In current dialysis practice, a dialysis fluid flow rate of
Even when the dialysis fluid flow rate equals the
either 500 mL/min or 800 mL/min (at a blood flow
blood flow rate (see red dots
rate > 350 mL/min) is commonly used, even though
the maximum small solute clearance is achieved.
optimal solute clearance is already achieved at much
Thus, higher dialysis fluid flow rates do not significantly
lower dialysis fluid flow rates.
contribute to an increase of clearances.
4Fig. 1),
almost 90% of
Effective Urea Clearance (mL/min)
300
QB = 350 mL/min
260
QB = 300 mL/min
220
QB = 250 mL/min
180
140
100
QB = QD: almost 90% of the maximum
small solute clearance is already achieved.
60
20
0
0
100
200
300
400
500
600
700
800
Dialysate Flow QD (mL/min)
Economic considerations
4Fig. 1: Small impact of dialysis fluid
flow rate on solute clearance relative to
varying blood flow rates (calculation for
treatment with FX 80, Hct 35%. rec. 5%)
dose of dialysis, it nevertheless represents the most
significant factor in terms of economic implications.
Although the primary target is to achieve the best
possible treatment conditions and outcomes, increasing
Through the application of the novel AutoFlow func-
patient numbers and a constantly deteriorating health
tion which is integrated in the 5008 Therapy System
of patients beginning dialysis have resulted in economic
and the 5008S Dialysis System, it is now possible to
restrictions for dialysis health care thereby necessitating
reduce significantly the dialysis fluid consumption and
a review of current practices.
thus the costs in terms of
The dialysis dose delivered to a patient is influenced
energy/electricity
by a number of factors: predominantly by the blood
water
flow rate, the selected dialyser, the treatment time,
waste water
the treatment mode and the dialysis fluid flow rate.
Although the dialysis fluid flow rate is the factor that
without compromising Kt/V.
has the least significant influence in determining the
The AutoFlow Function of the 5008 Therapy System
The AutoFlow function allows the user to accomplish
When the AutoFlow function is activated on the 5008,
an optimal ratio between blood flow rate and dialysis
the automatic adjustment of the dialysis fluid flow
fluid flow rate.
rate is based on the effective blood flow rate and a
constant factor chosen by the user.
QD = QB effective x AutoFlow Factor
Example (QB effective = 300 mL/min)
Factor 1.2:
Factor 1.3:
Factor 1.5:
QD = 300 mL/min x 1.2 = 360 mL/min
QD = 300 mL/min x 1.3 = 390 mL/min
QD = 300 mL/min x 1.5 = 450 mL/min
The dialysis fluid flow rate increases automatically
with an increasing blood flow rate
4Fig. 2,
thereby
ensuring an equal treatment efficiency for all conditions.
Effective Urea Clearance (mL/min)
500
Standard QD
AutoFlow Factor 1.5
AutoFlow Factor 1.2
400
QB = 400 mL/min
300
QB = 300 mL/min
200
QB = 200 mL/min
100
200
400
600
Dialysate Flow QD (mL/min)
800
1000
4Fig. 2: Relation of blood flow rate and dialysis fluid
flow rate in the 5008 Therapy System (activated
AutoFlow function, AutoFlow Factor 1.2, blue dots,
AutoFlow Factor 1.5, orange dots) resulting in only
very minor differences in clearance compared to
standard dialysis fluid flow rate (QD = 500 mL/min or
800 mL/min, red dots).
Optimising Dialysis Fluid Flow without Compromising Kt/V
Rather than being a simple mixture of water with acid
The activation of the AutoFlow function leads to a
and bicarbonate concentrates, dialysis fluid is also
reduced dialysis fluid flow rate and thus enables
required to have a very high chemical and microbio-
savings in dialysis fluid consumption (in comparison
logical quality an important feature with respect to
to standard treatments without the AutoFlow function)
patient safety. Moreover, energy is needed to heat the
of up to ~30%
4Table 1.
dialysis fluid to the appropriate temperature required
by the patient. Thus, dialysis fluids are highly valuable
entities and need to be used economically.
AutoFlow
Factor
QB effective
(mL/min)
QD
(mL/min)
Treatment
mode
Dialysis fluid
consumption
Saving
in Liter
Saving
in %
off *
300
500
HD
120 L
1.5
300
450
HD
108 L
12 L
10%
1.2
300
360
HD
86.4 L
33.6 L
28%
1.0
300
300
HDF (18 L)
90 L
30 L
25%
HD/HDF treatment with 5008; t = 4 h.
4Table 1: Reduced consumption of dialysis fluid with the AutoFlow function in HD and HDF treatments compared to a standard dialysis fluid flow rate of 500 mL/min
* Dialysate flow manually set to QD = 500 mL/min
However, it should be noted that the potential savings on dialysis fluid and energy (required to heat the
dialysis fluid) are dependent upon individual treatment conditions that may vary from one unit to another and
according to dialysis practices in different countries.
What happens to dialyser performances
and the Kt/V in treatments with a reduced
dialysis fluid flow rate?
in general, the decreases can be easily compensated
This of course depends on the chosen treatment
A switch to the ONLINE HDF mode ensures an equal
mode. Switching to HD treatment with the AutoFlow
or higher Kt/V while consuming a lower amount of
function may lead to a slight decrease in clearance.
dialysis fluid at the same effective blood flow rate
But the effect on Kt/V for a particular patient is likely
(calculation shown in
to remain below 0.1
in higher middle-molecule detoxification. A recent
4Table 2,
so that the differences
hardly have an effect on well-dialysed patients. In large
by a slight increase in the effective blood flow rate
(~20 mL/min).
4Table 2)
and results additionally
clinical study (1) has validated this data.
patients, or patients with a high recirculation, or even
AutoFlow
Factor
QB effective
(mL/min)
QD
(mL/min)
Treatment
mode
Dialysis fluid
consumption
Saving
in %
sp Kt/V
off *
300
500
HD
120 L
1.41
1.5
300
450
HD
108 L
10%
1.39
1.2
300
360
HD
86.4 L
28%
1.33
1.0
300
300
HDF (18 L)
90 L
25%
1.40
HD/HDF treatment with 5008; t = 4 h; FX 80; Hct = 35%; Recirculation = 5%, V = 40 L.
4Table 2: ONLINE HDF in combination with the AutoFlow function enables comparable doses of dialysis while saving dialysis fluid
* Dialysate flow manually set to QD = 500 mL/min
To facilitate the application of the AutoFlow Function,
AutoFlow factors for diverse machine and treatment
the figure below summarises the recommended
conditions.
Recommended AutoFlow Factors
Previously
Now
AutoFlow Factor
HD 4008
HD 5008 + AutoFlow
1.5
HD 4008
HDF 5008 + AutoFlow
1.0
HDF 5008 + AutoFlow
1.2
HDF 4008
HDF 5008
= HD
= HDF
The AutoFlow factor should be carefully adapted to
the Online Clearance Monitoring OCM, which is a
the individual needs of the patient. If the patient cannot
standard feature of the 5008 Therapy System and
achieve an adequate Kt/V, the AutoFlow factor should
the 5008S Dialysis System.
be increased stepwise until the prescribed target
dialysis dose has been reached.
This is best achieved by monitoring the actual dose
of dialysis during the treatment itself by means of
6
Practical Application of the AutoFlow Function
2 4
1
1 The AutoFlow function can be activated in the dialysate menu.
2 Press the button Factor to adjust the AutoFlow factor.
3 Press the AutoFlow button yes to activate the function.
4 AutoFlow factors between 1.0 and 2.0 can be applied in steps of 0.1.
4Fig. 4: Dialysate menue of the 5008 Therapy System and the 5008S Dialysis System.
The standard setting of the AutoFlow factor is 1.5. This pre-setting can be adjusted in the user set-up menu
(for constant changes) or for individual treatments.
Reference
1. Kult, J and Stapf, E, Changing emphasis in modern hemodialysis therapies: Cost-effectiveness of delivering higher doses of dialysis, Int J Art Organs (2007);
30(7); 577-582
certified.
Copyright 2008 Fresenius Medical Care Deutschland GmbH
736 193 1/1 GB (1,0 V&B 06.08)
Fresenius Medical Care Deutschland GmbH 61346 Bad Homburg v. d. H. Germany Phone: +49 (0) 6172-609-0 Fax: +49 (0) 6172-609-2191
Head ofce: Else-Krner-Strae 1 61352 Bad Homburg v. d. H.
www.fmc-ag.com
Recommended AutoFlow Factors
Previously
Now
AutoFlow Factor
HD 4008
HD 5008 + AutoFlow
1.5
HD 4008
HDF 5008 + AutoFlow
1.0
HDF 5008 + AutoFlow
1.2
HDF 4008
HDF 5008
= HD
= HDF
Practical Application of the AutoFlow Function
1 The AutoFlow function can be activated in the dialysate menu.
2 Press the button Factor to adjust the AutoFlow factor.
3 Press the AutoFlow button yes to activate the function.
4 AutoFlow factors between 1.0 and 2.0 can be applied in
3
2 4
steps of 0.1.
The standard setting of the AutoFlow factor is 1.5. This pre-setting
can be adjusted in the user set-up menu (for constant changes)
or for individual treatments.
