Abstract

Background and Objective: In Iran, dialysis adequacy is low in more than 60 of hemodialysis patients. Dialysis inadequacyisa main cause of morbidity and mortality in dialysis patients. Resistance of filter boundary layer and poor distribution of dialysate flow are important factors limitingthe adequacy. Ascending and descending stepwise dialysate flowrate profiles are two methods to improve fluid distribution and dialysis adequacy and each maydiffer with the other in terms of patient comfort andcomplications. Methodology: In this quasi-experimental, single group, pre-and post-intervention research, 22 hemodialysis patients covered by the SpecialPatients Center of Zabol were dialyzed through the routine method (dialysate flow rate of 500 min/mL) andascending and descending stepwise dialysateflow rate profiles, while keeping constant all parameters(such as filter type, blood flow rate, type and concentration of dialysate, shift, etc.). The patients were dialyzed through each method for 2 sessions. To assess the adequacy of dialysis, BUN was measured at the beginning and end of the second session of each method before and after dialysis. During the sixth sessions of dialysis, patients were checked before dialysis in terms ofblood pressure, symptoms such as nausea, vomiting, muscle cramps, headaches, and other symptoms andthen their blood pressure, nausea, vomiting, muscle cramps, and headaches were directly monitored every 30 minutes. Findings: The mean score of dialysis adequacy was 0.834+/-0.22 in the routine method, 1.0032+/-0.28 in the ascending stepwise dialysate flow rate profile, and1.07+/-0.35 in the descending stepwise dialysate flow rate profile. According to paired t-test, the difference between routine and each of the stepwise profiles was significant (p=0.000). But there was no significant difference between routine and stepwise dialysate flow rate profile in terms of complications (headache, muscle cramps, nausea, vomiting, etc.)(p<0.05). There was no significant difference between the mean scores of dialysis adequacy in ascending and descending stepwise dialysate flow rate profiles(p=0.346), however, according to chi-square test, a significant difference existed between these two profiles in terms of complicationssuch as headache (p=0.026). Conclusion: The stepwise dialysate flow rate profileis an efficient method for increasing dialysis adequacy andthe ascending stepwise profileis more appropriate to improve dialysis adequacy than the routine method due to insignificant complications, and thanthe descending stepwise profile due to lower complications.