{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:52:49Z","timestamp":1788317569860,"version":"build-2803163510"},"reference-count":29,"publisher":"S. Karger AG","issue":"2","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Blood Purif"],"abstract":"<jats:p>Introduction: The standard dialysate flow (Qd) for hemodialysis (HD) is currently set at 500 mL\/min. One potential, sustainable, and cost-effective solution for eco-friendly HD may involve reducing Qd to limit wastewater. However, the effect of reduced Qd on small molecule and middle molecule (MM) removal remains to be investigated. Methods: In this prospective observational study, 74 patients on different maintenance dialysis modalities with Qd set at 500 mL\/min (Qd500) were assigned to receive Qd at 400 mL\/min (Qd400) for 3 months. Dialysis adequacy, including small solute removal and MM reduction ratio (RR), was evaluated at enrollment and after 3 months. Results: Compared to Qd500, Qd400 after 3 months achieved similar single-pool Kt\/V (1.41 \u00b1 0.30 vs. 1.43 \u00b1 0.33, p = 0.58), equilibrated KT\/V, urea RR, creatinine RR, and phosphate RR. Qd400 vs. Qd500 provided significantly higher beta2-microglobulin RR (77.0 [71.4\u201381.7] vs. 74.7 [68.4\u201379.4] %, p = 0.009) and lower kappa free light chain (FLC) RR (54.2 [42.1\u201364.4] vs. 57.6 [41.6\u201365.0] %, p = 0.03), whereas myoglobin and lambda FLC RR were similar. Qd400 resulted in higher pre-dialysis urea (20.2 \u00b1 5.5 vs. 18.2 \u00b1 6.2 mmol\/L, p = 0.002), creatinine (694.0 \u00b1 179.5 vs. 665.6 \u00b1 220.4 \u00b5mol\/L, p = 0.029), beta2-microglobulin (26.5 [23.0\u201330.0] vs. 23.5 [20.0\u201328.0] mg\/L, p = 0.0001), and myoglobin (174.0 [122.0\u2013251.0] vs. 159.5 [119.0\u2013195.0] \u00b5g\/L, p = 0.033) levels. Pre-dialysis levels of albumin, potassium, bicarbonate, phosphate, and calcium were similar between Qd400 and Qd500. Conclusion: Three months of Qd at 400 mL\/min appears to provide similar small molecule and MM removal, but with an increase in pre-dialysis urea, creatinine, beta2-microglobulin, and myoglobin levels. Although this strategy could help preserve water, its potential impact on long-term clinical outcomes deserves further evaluation.<\/jats:p>","DOI":"10.1159\/000549110","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T16:01:13Z","timestamp":1761062473000},"page":"138-147","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Reduced Dialysate Flow on Dialysis Adequacy: A Pilot 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