We have located links that may give you full text access.
Evaluation Studies
Journal Article
Assessment of haemodialysis adequacy by ionic dialysance: intra-patient variability of delivered treatment.
Nephrology, Dialysis, Transplantation 2003 March
INTRODUCTION: Adequate delivered dose of solute removal (as assessed by urea reduction and calculation of Kt/V) is an important determinant of clinical outcome in chronic haemodialysis (HD) patients. The requirement for multiple blood sampling and efforts taken to minimize the effects of rebound on post-treatment samples ensure Kt/V is measured only intermittently. On-line conductivity monitoring (using sodium flux as a surrogate for urea) allows the repeated non-invasive measurement of Kt/V on each HD treatment. We have studied the accuracy of this method of measuring Kt/V, and the variability of treatment dose delivered to individual patients.
METHODS: We prospectively studied 26 established chronic HD patients over 4 weeks (316 treatments). Patients were dialysed using Hospal Integra dialysis monitors, equipped with Diascan modules to measure Kt/V. Data were downloaded automatically to a central computer server. Urea reduction was measured (once a week) by a two-pool calculation using 30 min post-treatment sampling.
RESULTS: Treatment time, Q(B) and modality were fully delivered in all treatments analysed (97% of total). Kt/V measured by ionic dialysance (Kt/V(ID)) correlated highly with that derived from measurement of urea reduction (R(2)=0.92, P<0.0001). Kt/V(ID) underestimated urea-based Kt/V by a mean of only 1.5% (95% CI 0.18-2.9%). Kt/V(ID) varied greatly within individual patients with a mean CV of 0.13+/-0.10 (95% CI 0.05-0.3). If a Kt/V(ID) of 1.0 is considered 'adequate', 55% of the patients had variations that would have potentially altered their status as being adequately or inadequately dialysed, as the range of Kt/V readings cross that point during the study period.
CONCLUSION: In conclusion, Kt/V(ID) seems to be an accurate and readily obtained measure of adequacy. Substantial variation in Kt/V implies repeated measures (ideally for all treatments) are necessary to gain a true picture of the mean treatment dose being delivered to patients.
METHODS: We prospectively studied 26 established chronic HD patients over 4 weeks (316 treatments). Patients were dialysed using Hospal Integra dialysis monitors, equipped with Diascan modules to measure Kt/V. Data were downloaded automatically to a central computer server. Urea reduction was measured (once a week) by a two-pool calculation using 30 min post-treatment sampling.
RESULTS: Treatment time, Q(B) and modality were fully delivered in all treatments analysed (97% of total). Kt/V measured by ionic dialysance (Kt/V(ID)) correlated highly with that derived from measurement of urea reduction (R(2)=0.92, P<0.0001). Kt/V(ID) underestimated urea-based Kt/V by a mean of only 1.5% (95% CI 0.18-2.9%). Kt/V(ID) varied greatly within individual patients with a mean CV of 0.13+/-0.10 (95% CI 0.05-0.3). If a Kt/V(ID) of 1.0 is considered 'adequate', 55% of the patients had variations that would have potentially altered their status as being adequately or inadequately dialysed, as the range of Kt/V readings cross that point during the study period.
CONCLUSION: In conclusion, Kt/V(ID) seems to be an accurate and readily obtained measure of adequacy. Substantial variation in Kt/V implies repeated measures (ideally for all treatments) are necessary to gain a true picture of the mean treatment dose being delivered to patients.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app