Efficacy of dialysis in peritoneal dialysis: utility of bioimpedance to calculate Kt/V and the search for a target Kt

Objectives: To compare different methods of calculating adequacy of hemodialysis in terms of Kt/V. Methods: This was an observational, quantitative study undertaken after the approval of Internal Review Board at the Hemodialysis Unit of Nephrology department, Mayo Hospital, Lahore from 1st December 2018 to 30th June 2019. Sixty hemodynamically stable patients of end stage renal disease undergoing hemodialysis for more than three months with age 18 to 70 years were included in the study by convenience non probability sampling. Critically ill patients with multiple co-morbidities like sepsis (i.e. total leukocyte count >11000 or <4000 x 109/L), ischemic heart disease, pace- makers, malignancies, cirrhosis etc were excluded. Patients who were not adherent to dialysis prescription or hemodynamically unstable were also excluded. One way ANOVA and Pearson’s correlation were used to find correlation between three methods of measuring Kt/V. Results: Mean ultrafiltration was 2.1+ 0.76 liter/session. Pre dialysis weight was 64.7 +14.7 kgs, mean post dialysis weight was 62.5 + 14.7 kgs. For every patient blood flow rate was 300 ml/m and dialysis flow rate was 500 ml/min. The mean values of Kt/V measured by Daugirdas formula was 1.35 ± 0.33, mean online clearance monitoring (OCM) value was 1.17 ± 0.29 and by normogram was 1.36 ± 0.33. There was positive significant correlation between values of Daugirdas formula, Normogram and online clearance monitoring (OCM) i.e. r = 0.897 (p-value < 0.001) measured by Pearson’s correlation and one way-ANOVA. Conclusion: Online clearance monitoring can be used for measuring adequacy of hemodialysis, but OCM slightly underestimates Kt/V as compared to Daugirdas formula and Normogram. doi: https://doi.org/10.12669/pjms.38.1.4281 How to cite this:Fazl-e-Mateen, Ahmad S, Elahi I, Anees M. Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis. Pak J Med Sci. 2022;38(1):167-171. doi: https://doi.org/10.12669/pjms.38.1.4281 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

show abstract

“…While some studies also used other methods to measure Volume of distribution like Bioimpedence method. 11 …”

Section: Discussionmentioning

confidence: 99%

Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis

Mateen

Ahmad²,

Elahi³

et al. 2021

Pak J Med Sci

View full text Add to dashboard Cite

show abstract

“…We proceeded to the recording of impedance, resistance, reactance, and phase angles and the subsequent transformation into estimates of lean body mass, body fat, cell mass, total body water, and intracellular water. [23,24]…”

Section: Methodsmentioning

confidence: 99%

Peritoneal dialysis in older adults

et al. 2018

View full text Add to dashboard Cite

The number of older adults requiring dialysis is increasing worldwide, whereas the use of peritoneal dialysis (PD) in this population is lower with respect to younger patients, despite the theoretical advantages of PD respect to hemodialysis. This is most likely due to the concern that older patients may not be able to correctly and safely manage PD.We aimed to prospectively compare clinical, nutritional and metabolic outcomes and measures of quality of life between younger (<65 years old) and older (≥65 years old) patients on PD.PD patients were enrolled and divided into 2 groups according to age (Group A < 65 years, Group B ≥ 65 years). Clinical and instrumental parameters, and quality of life were evaluated at baseline (start of PD) (T0) and at 24 months (T1). Technique survival, mortality, total number of hospitalizations, and the index of peritonitis (episodes of peritonitis/month) were also evaluated.Fifty-one patients starting PD were enrolled. Group A included 22 patients (48.7 ± 8.3 years), and Group B consisted of 29 patients (74.1 ± 6.4 years). At baseline, the 2 groups showed no differences in cognitive status, whereas Group A showed higher total cholesterol (P = .03), LDL (P = .03), and triglycerides (P = .03) levels and lower body mass index (P = .02) and carotid intima media thickness (P < .0001) with respect to Group B. At T1 Group B showed, compared to baseline, a significant reduction in albumin (P < .0001) and phosphorus (P = .045) levels, while no significant differences on body composition, technique survival, total number of hospitalizations, index of peritonitis, and quality of life indices were observed.Our data do not show clinically relevant barriers to use PD in older adult patients, supporting its use in this population. Nutritional and metabolic parameters should be carefully monitored in older PD patients.

show abstract

“…Assuming that this compartment generates uremic toxins, dialysis dose should be proportionally higher in small patients . Corroborating this, several studies assessed outcomes with Kt alone as dose index and found a more straightforward relationship to odds of death than with Kt/V . However, several of the characteristics associated with lower Kt are by themselves related to risk, such as age, central vein catheters or inadequate dialyzer blood flow (corresponding to access problems and dismal vascular status) …”

Section: Invalidity Of Kt/v In Specific Populationsmentioning

confidence: 99%

“…The definition of V, inherent to the continuous nature of PD, relies on anthropometric formulae. When Kt is normalized to other indices of body mass, subgroup analyses have pointed out discrepancies in adequacy that were not unraveled by considerations of classical Kt/V . Thus, estimating urea distribution in PD is subject to significant error …”

Section: Invalidity Of Kt/v With Specific Dialysis Strategiesmentioning

confidence: 99%

A swan song for Kt/V_urea

Vanholder

Biesen

Lameire

2019

Seminars in Dialysis

View full text Add to dashboard Cite

Dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume (Kt/Vurea or simply Kt/V) has been used as an index of dialysis adequacy since more than 30 years. This article reviews the flaws of Kt/V, starting with a lack of proof of concept in three randomized controlled hard outcome trials (RCTs), and continuing with a long list of conditions where the concept of Kt/V was shown to be flawed. This information leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete. The dialysis patient might benefit more if, instead, the nephrology community concentrates in the future on pursuing the optimal dialysis dose that conforms with adequate quality of life and on factors that are likely to affect outcomes more than Kt/V. These include residual renal function, volume status, dialysis length, ultrafiltration rate, the number of intra‐dialytic hypotensive episodes, interdialytic blood pressure, serum potassium and phosphate, serum albumin, and C reactive protein.

show abstract

Efficacy of dialysis in peritoneal dialysis: utility of bioimpedance to calculate Kt/V and the search for a target Kt

Cited by 6 publications

References 27 publications

Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis

Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis

Peritoneal dialysis in older adults

A swan song for Kt/V_urea

Contact Info

Product

Resources

About

Efficacy of dialysis in peritoneal dialysis: utility of bioimpedance to calculate Kt/V and the search for a target Kt

Cited by 6 publications

References 27 publications

Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis

Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis

Peritoneal dialysis in older adults

A swan song for Kt/Vurea

Contact Info

Product

Resources

About

A swan song for Kt/V_urea