A mechanistic analysis of the National Cooperative Dialysis Study (NCDS)

Gotch, Frank A.; Sargent, John

doi:10.1038/ki.1985.160

Cited by 1,239 publications

(683 citation statements)

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“…The present NECOSAD analysis did not indicate that treatment duration itself may contribute to patient survival, which is in accordance with some other reports (1)(2)(3)7,33). However, an important drawback of the observational NECOSAD study is the restriction to treatment characteristics that are usually present in current dialysis practice.…”

Section: Discussionsupporting

confidence: 81%

“…The results of the National Cooperative Dialysis Study (NCDS) have led to the development of Kt/V urea to quantify the dialysis dose in ESRD patients who are treated with hemodialysis (HD) (1,2). In various studies, it was found that the Kt/V urea (or the urea reduction ratio as equivalent parameter) is an important predictor of morbidity and mortality (3)(4)(5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

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Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

Termorshuizen

Dekker²,

Manen³

et al. 2004

Journal of the American Society of Nephrology

320

273

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Abstract.A high delivered Kt/V urea (dKt/V urea ) is advocated in the U.S. National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines on hemodialysis (HD) adequacy, irrespective of the presence of residual renal function. The contribution of treatment adequacy and residual renal function to patient survival was investigated. The Netherlands Cooperative Study on the Adequacy of Dialysis is a prospective multicenter study that includes incident ESRD patients older than 18 yr. The longitudinal data on residual renal function and dialysis adequacy of patients who were treated with HD 3 mo after the initiation of dialysis (n ϭ 740) were analyzed. The mean renal Kt/V urea (rKt/V urea ) at 3 mo was 0.7/wk (SD 0.6) and the dKt/V urea at 3 mo was 2.7/wk (SD 0.8). Both components of urea clearance were associated with a better survival (for each increase of 1/wk in rKt/V urea , relative risk of death ϭ 0.44 [P Ͻ 0.0001]; dKt/V urea , relative risk of death ϭ 0.76 [P Ͻ 0.01]). However, the effect of dKt/V urea on mortality was strongly dependent on the presence of rKt/V urea , low values for dKt/ V urea of Ͻ2.9/wk being associated with a significantly higher mortality in anuric patients only. Furthermore, an excess of ultrafiltration in relation to interdialytic weight gain was associated with an increase in mortality independent of dKt/V urea . In conclusion, residual renal clearance seems to be an important predictor of survival in HD patients, and the dKt/V urea should be tuned appropriately to the presence of renal function. Further studies are required to substantiate the important role of fluid balance in HD adequacy.

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

Termorshuizen

Dekker²,

Manen³

et al. 2004

Journal of the American Society of Nephrology

320

273

View full text Add to dashboard Cite

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“…With the exception of the National Cooperative Dialysis Study (23) and the HEMO Study (2), most efforts to determine optimal dialysis dose have come from examination of the relationship between dose and mortality in observational studies. One problem with analyzing datasets from observational studies is confounding of the dose of dialysis, be it urea reduction ratio, spKt/V, eKt/V, or stdKt/V, with body size.…”

Section: Discussionmentioning

confidence: 99%

Dialysis Dose Scaled to Body Surface Area and Size-Adjusted, Sex-Specific Patient Mortality

Ramirez

Kapke

Port

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives When hemodialysis dose is scaled to body water (V), women typically receive a greater dose than men, but their survival is not better given a similar dose. This study sought to determine whether rescaling dose to body surface area (SA) might reveal different associations among dose, sex, and mortality.Design, setting, participants, & measurements Single-pool Kt/V (spKt/V), equilibrated Kt/V, and standard Kt/V (stdKt/V) were computed using urea kinetic modeling on a prevalent cohort of 7229 patients undergoing thriceweekly hemodialysis. Data were obtained from the Centers for Medicare & Medicaid Services 2008 ESRD Clinical Performance Measures Project. SA-normalized stdKt/V (SAN-stdKt/V) was calculated as stdKt/V 3 ratio of anthropometric volume to SA/17.5. Patients were grouped into sex-specific dose quintiles (reference: quintile 1 for men). Adjusted hazard ratios (HRs) for 1-year mortality were calculated using Cox regression.Results spKt/V was higher in women (1.760.3) than in men (1.560.2; P,0.001), but SAN-stdKt/V was lower (women: 2.360.2; men: 2.560.3; P,0.001). For both sexes, mortality decreased as spKt/V increased, until spKt/V was 1.6-1.7 (quintile 4 for men: HR, 0.62; quintile 3 for women: HR, 0.64); no benefit was observed with higher spKt/V. HR for mortality decreased further at higher SAN-stdKt/V in both sexes (quintile 5 for men: HR, 0.69; quintile 5 for women: HR, 0.60).Conclusions SA-based dialysis dose results in dose-mortality relationships substantially different from those with volume-based dosing. SAN-stdKt/V analyses suggest women may be relatively underdosed when treated by V-based dosing. SAN-stdKt/V as a measure for dialysis dose may warrant further study.

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“…Std K is multiplied by session time and divided by V to obtain Std Kt/V. Urea generation and V are calculated using traditional urea kinetic modeling (UKM) (13). The formula takes into account the number of treatments per week and urea rebound by using Daugirdas's eKt/V correction of the Sp Kt/V (14).…”

Section: Methodsmentioning

confidence: 99%

Cystatin C Levels in Functionally Anephric Patients Undergoing Dialysis

Al-Malki¹,

Heidenheim²,

Filler³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Cystatin C, a low molecular weight protein, is produced by nucleated cells, filtered by glomeruli, and degraded by tubules at a constant rate. Its serum concentration has been proposed as a marker of GFR. Its size should make it dialyzable. It is hypothesized that serum cystatin C levels are influenced by the method and intensity of dialysis received.Design: This is a cross-sectional pilot study of cystatin C in functionally anephric dialysis patients. It was measured predialysis in 14 patients on conventional (3 to 5 h, 3 ؋ wk) hemodialysis; eight on nocturnal hemodialysis (three to seven nights, 6 to 8 h); three on daily hemodialysis (6 d, 1 1 ⁄2 to 2 1 ⁄2 h); and 10 on automated peritoneal dialysis. All had urea kinetic studies and values for single pool Kt/V (Sp Kt/V), standard weekly Kt/V (Std Kt/V), and protein equivalent of nitrogen appearance (nPNA; g/kg/d). C reactive protein (CRP; mg/L) and thyroid stimulating hormone (TSH; mIU/L) were measured as factors known to influence cystatin C.Results: There was no correlation between cystatin C and Sp Kt/V, but there was a significant inverse linear correlation with Std Kt/V and there were significant differences between treatment modalities in cystatin C levels and in Std Kt/V. The estimation of cystatin C was reliable and stable over 3 to 6 wk and its levels uninfluenced by nPNA, CRP, or TSH.Conclusion: Serum cystatin C levels are influenced by the method and intensity of dialysis and may have a role in treatment adequacy monitoring.

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A mechanistic analysis of the National Cooperative Dialysis Study (NCDS)

Cited by 1,239 publications

References 0 publications

Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

Dialysis Dose Scaled to Body Surface Area and Size-Adjusted, Sex-Specific Patient Mortality

Cystatin C Levels in Functionally Anephric Patients Undergoing Dialysis

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