The goal of this clinical trial is to detect if lower dialysate flow rate can affect hemodialysis adequacy , dialysis recovery time and patients quality of life.

The main questions it aims to answer are:

does low dialysate flow affect hemodialysis adequacy? does green dialysis achievable without affecting hemodialysis adequacy? Researchers will compare hemodialysis session of high dialysate flow to that with low dialysate flow.

Participants will:

underwent hemodialysis for a week with low dialysate flow and another week with high dialysate flow.

Inclusion Criteria:

• ESKD patients more than or equal 18 years old, on maintenance HD thrice weekly for more than three months and each session lasts for 4 hours.
• All patients will receive HD via an arterio-venous fistula.
• All patients will receive HD via the same type of HD machine and the blood pump will be set at 300ml/min.
• All patients will receive the same type of HD membranes and every effort will be made to achieve the dry weight of the patients.

Exclusion Criteria :

• Critically ill and hospitalized ESKD patients.
• Mentally disabled patients.
• Patients with terminal malignancy or receiving chemotherapy.
• Patients receiving immune suppression treatment.