Hemodialysis Therapy and Treatment Time

• Published in: Journal of Japanese Society for Home Hemodialysis Vol. 3; no. 2; pp. 66 - 73
• Main Author: Koda, Yutaka
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Home Hemodialysis 28.12.2023; 一般社団法人 日本在宅血液透析学会
• Subjects: Body fluid compartment; hemodialysis; Kt/V; middle molecule toxins; treatment time; 中分子毒素; 体液区画; 血液透析; 透析時間
• ISSN: 2435-2519
• DOI: 10.34505/jshhd.3.2_66

In hemodialysis, which is an intermittent treatment, treatment time affects various aspects. A large-scale prospective interventional trial conducted in the United States in the 1970s did not show a significant prognostic factor for the length of treatment, thus justifying the policy of increasing clearance and shortening treatment time. However, some uremic toxins have great resistance to move between compartments in the body, and they cannot be removed sufficiently without taking a long treatment time. Phosphorus and middle molecules fall into this category. A longer treatment time is also advantageous for avoiding the risk of dialysis hypotension and normalizing the extracellular fluid volume and is associated with a better prognosis. Even if the same dose of Kt/V is achieved, it is important to increase the time (t) to achieve it. However, in a survey of dialysis patients' requests and priorities for treatment, there were an unexpectedly high number of requests for "shorter dialysis time". Hemodialysis is a "complete obligation" for dialysis patients, whereas hemodialysis itself is an "imperfect treatment". It is similar to seeking a goal without a correct answer, and the process of discussion itself with patient could be the goal.