Double target comparison of blood-side methods for measuring the hemodialysis dose

Prado, Manuel; Roa, Laura M.; Palma, Alfonso; Milen, Jose A.

doi:10.1111/j.1523-1755.2005.00760.x

Cited by 9 publications

(7 citation statements)

References 55 publications

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“…2 The various models have been recently well summarized and compared. 24 The new method 1 evaluated here, however, proposes a more direct use for the new technology that is predictably associated with death risk. As such, it is a valid method for judging dialysis dose if OLC measurements are available.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating a new method to judge dialysis treatment using online measurements of ionic clearance

Lowrie

Ofsthun

et al. 2006

Kidney International

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New technology now supports direct online measurements of total dialysis dose per treatment, Kt. An outcome-based, nonlinear method for estimating target Kt in terms of ionic clearance measurements and body surface area (BSA) has been described recently. This is a validation study of the new method that evaluates the relationship between the (actual Kt-target Kt) difference and death risk. Patients with Kt measurements during March 2004 were identified (N=59,644). Target Kt was determined for each patient using the new method. Patients were then grouped by (actual Kt-target Kt) decile. They were also grouped by (actual URR-target URR) decile. Cox analysis-based risk profiles were constructed using those groupings. The (actual Kt-target Kt) difference profiles suggested improving death risk as Kt increased from below target to equal target. Risk ratios then flattened and remained so until (actual Kt-target Kt) reached the highest decile at which it appeared to improve, suggesting a possible biphasic profile. The (URR-target URR) risk profile was U-shaped. Death risk was related to the difference between the actual Kt and a target Kt value selected using the new nonlinear method. The method is therefore valid for prescribing and monitoring hemodialysis treatment.

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Section: Discussionmentioning

confidence: 99%

“…As such, it is a valid method for judging dialysis dose if OLC measurements are available. It is fortunate that clinicians can now choose to use either direct Kt measurements or a urea-based method 24 to prescribe and monitor dialysis dose for their patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluating a new method to judge dialysis treatment using online measurements of ionic clearance

Lowrie

Ofsthun

et al. 2006

Kidney International

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“…The benefits and drawbacks of different methods to determine dialysis dose have been discussed earlier [1,22,23], and only a few arguments should be called to mind here.…”

Section: Discussionmentioning

confidence: 99%

“…The second-generation Daugirdas’ formula was modeled from 500 HD sessions, and its total error remains in an acceptable 5% range throughout the investigated range of dialysis doses (0.7 ≤ Kt/V ≤ 2.0) [8]. This method is one out of several methods with significant differences, but it is established as standard in clinical routine [22,23]. …”

Section: Discussionmentioning

confidence: 99%

Determination of Dialysis Dose: A Clinical Comparison of Methods

Ahrenholz

Táborský²,

Bohling

et al. 2011

Blood Purif

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Background: Guidelines recommend regular measurements of the delivered hemodialysis dose Kt/V. Nowadays, automatic non-invasive online measurements are available as alternatives to the conventional method with blood sampling, laboratory analysis, and calculation. Methods:In a prospective clinical trial, three different methods determining dialysis dose were simultaneously applied: Kt/V_Dau (conventional method with Daugirdas’ formula), Kt/V_OCM [online clearance measurement (OCM) with urea distribution volume V based on anthropometric estimate], and Kt/V_BCM [OCM measurement with V measured by bioimpedance analysis (Body Composition Monitor)]. Results:1,076 hemodialysis patients were analyzed. The dialysis dose was measured as Kt/V_Dau = 1.74 ± 0.45, Kt/V_OCM = 1.47 ± 0.34, and Kt/V_BCM = 1.65 ± 0.42. The difference between Kt/V_OCM and Kt/V_BCM was due to the difference between anthropometric estimated V_Watson and measured V_BCM. Compared to Kt/V_Dau, Kt/V_OCM was 15% lower and Kt/V_BCM 5% lower. Kt/V_Dau was incidentally prone to falsely high values due to operative errors, whereas in these cases OCM-based measurements Kt/V_OCM and Kt/V_BCM delivered realistic values. Conclusions:The automated OCM Kt/V_OCM with anthropometric estimation of urea distribution volume was the easiest method to use, but Kt/V_BCM with measured urea distribution volume was closer to the conventional method.

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“…In current practice, high-flux (HF) dialyzers may allow more efficient removal of larger molecules, which is expected to reduce the risk of HD-related morbidity and mortality substantially. Conversely, no consensus exists concerning the best dialysis dose index and method for calculating it [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Application of Cystatin C Reduction Ratio to High-Flux Hemodialysis as an Alternative Indicator of the Clearance of Middle Molecules

Park

Kim

Kang

et al. 2010

Korean J Intern Med

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Background/Aims: Although high-flux (HF) dialyzers with enhanced membrane permeability are widely used in current hemodialysis (HD) practice, urea kinetic modeling is still being applied to indicate the adequacy of both low-flux (LF) and HF HD. In comparison with urea (molecular weight, 60 Da) and β2-microglobulin (β2MG, 12 kDa), cystatin C (CyC, 13 kDa) is a larger molecule that has attractive features as a marker for assessing solute clearance. We postulated that CyC might be an alternative for indicating the clearance of middle molecules (MMs), especially with HF HD. Methods: Eighty-nine patients were divided into LF and HF groups. Using single pool urea kinetic modeling, the urea reduction ratio (URR) and equilibrated Kt/Vurea (eKt / Vurea) were calculated. The serum CyC concentrations were measured using particle-enhanced immunonephelometry. As indices of the middle molecular clearance, the reduction ratios of β2MG and CyC were calculated. Results: The β2MG reduction ratio (β2MGRR) and CyC reduction ratio (CyCRR) were higher in the HF group compared to the LF group. However, the URR and eKt/Vurea did not differ between the two groups. The CyCRR was significantly correlated with the eKt/Vurea and β2MGRR (r = 0.47 and 0.69, respectively, both p < 0.0001). Conclusions: Compared to the LF dialyzer, the HF dialyzer removed CyC and β2MG more efficiently. Unlike the β2MGRR, the CyCRR was correlated with the eKt / Vurea and β2MGRR. This study suggests a role for the CyCRR as an alternative indicator of the removal of MMs. (Korean J Intern Med 2010;25:77-81)

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Double target comparison of blood-side methods for measuring the hemodialysis dose

Abstract: We have confirmed the arguments that support the hypothesis of the study. The best blood-side methods for the combined measurement of dialysis dose as a function of the available resources have been determined.

Cited by 9 publications

References 55 publications

Evaluating a new method to judge dialysis treatment using online measurements of ionic clearance

Evaluating a new method to judge dialysis treatment using online measurements of ionic clearance

Determination of Dialysis Dose: A Clinical Comparison of Methods

Application of Cystatin C Reduction Ratio to High-Flux Hemodialysis as an Alternative Indicator of the Clearance of Middle Molecules

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