Haemodialysis with on-line monitoring equipment: tools or toys?

Locatelli, Francesco; Buoncristiani, U; Canaud, Bernard; Köhler, H.; Petitclerc, Thierry; Zucchelli, P

doi:10.1093/ndt/gfh555

Cited by 115 publications

(81 citation statements)

References 42 publications

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“…The high degree of correlation between Kt/V (ID) and Kt/V (UR) shows without doubt that the new method of direct dialysis dose quantification could be more frequently used. [12] In addition, in our study there was a high degree of correlation between two methods used, which has already been confirmed in other studies. [14,15] We also found a slight underestimation of values obtained by ionic dialysance according to standard urea removal procedure.…”

Section: Discussionsupporting

confidence: 90%

“…The importance of such approach has been confirmed by other authors. [12] In conclusion, assessment of the delivered dialysis dose by ionic dialysance seems to be comparable with the standard method of urea removal and sufficient to be useful in everyday clinical practice. Due to slight underestimation and some intrapatient variability, we suggest the use of average values for each patient obtained in single session, rather than a single value.…”

Section: Discussionmentioning

confidence: 76%

“…Conductivity monitoring appears the most versatile tool, as it permits quantification of delivered dialysis dose, potentially at each dialysis session and without extra cost. [12] The aim of this study was to determine the value of ID for assessment of delivered dialysis dose (Kt/V) in comparison to standard UR procedure.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Hemodialysis Adequacy by Ionic Dialysance: Comparison to Standard Method of Urea Removal

et al. 2005

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Background. The hemodialysis adequacy is one of the most important issues influencing the survival of patients on maintenance hemodialysis (HD). Assessment of measuring the delivered dialysis dose using clearance Â time/volume (Kt/V) index requires multiple blood sampling. New methods for assessment of dialysis dose based on ionic dialysance (ID) have been suggested. Online conductivity monitoring (using sodium flux as a surrogate for urea) allows the repeated noninvasive measurement of Kt/V on each HD treatment. In this study we have compared this method with the standard method of estimating Kt/V. Methods. We studied 24 established HD patients over a 4 week time period. Patients were dialyzed using Fresenius 4008S dialysis monitors, equipped with modules to measure ID. Data were manually collected and analyzed using the appropriate statistical software. Urea removal (UR) was measured once a week by a two-pool calculation, estimating an eKt/V. Results. The Kt/V measured by ID highly correlated with the one derived from the measurement of the UR (r = 0.8959, p < 0.0001). The ID underestimated UR by the mean of 6%. The ID varied greatly within individual patients with a median of 1.29 ± 0.22. If the eKt/V ! 1.2 is considered adequate, 33% of the patients would have been inadequately dialyzed. The mean HD duration to achieve an adequate dialysis was 4 hours and 47 minutes with high interpatient variability. Conclusion. The ID seems to be an easily obtained measure of the delivered dialysis dose, correlating well with standard UR method. Substantial individual variations imply that repeated measures (ideally for all treatments) are necessary to obtain a real answer to the mean treatment dose being delivered to the patients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 76%

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Assessment of Hemodialysis Adequacy by Ionic Dialysance: Comparison to Standard Method of Urea Removal

et al. 2005

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“…Online methods are considered to be more accurate than methods based on pre-and post-dialysis urea concentrations and have been found to be better suited to clinical routines. Online monitoring of the dialysis dose has been suggested as a valuable tool in ensuring adequate dialysis prescription (Locatelli, 2005).…”

Section: Dialysis Adequacy and Online Monitoringmentioning

confidence: 99%

Optical Dialysis Adequacy Monitoring: Small Uremic Toxins and Contribution to UV-Absorbance Studied by HPLC

Lauri¹,

Arund²,

Holmar³

et al. 2011

Progress in Hemodialysis - From Emergent Biotechnology to Clinical Practice

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“…Effective ionic dialysance has been assumed to be equivalent to effective urea clearance because of the similar molecular weight and osmotic distribution volumes of sodium chloride and urea. This assumption allows the calculation of Kt/V by using the mean ionic dialysance throughout the session as the K value, the real duration of the session as the t value, and the urea distribution volume as V, calculated either as 55% of the body weight or with anthropometric formulas (13). Increasingly, HD machines incorporate devices that measure ionic dialysance, allowing the dialysis dosage to be determined noninvasively in real time and in each session.…”

Section: Kt/v Urea and Online Quantification Of Dialysis Dosagementioning

confidence: 99%

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

Lameire¹,

Biesen²,

Vanholder³

2009

Clinical Journal of the American Society of Nephrology

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During the past two decades, impressive technological innovations have been introduced in the field of hemodialysis. This review analyzes whether these have been translated into better patient survival. The potential impacts of an increase in dialysis dosage, the preference of high-flux versus low-flux membranes, the choice between convection and diffusion as dialysis strategy, the chemical composition and biologic purity of dialysate, the effect of sodium, potassium, volume profiling, and the intradialytic volume monitoring aiming at improving hemodynamic stability are explored. Studies in which the dialysis dosage was increased were not associated with increased patient survival, whereas the superiority of high-flux over low-flux membranes is not convincingly demonstrated. Although strict evidence is lacking, observational data suggest an advantage of convective over pure diffusive strategies. Longer duration of the dialysis sessions and/or higher frequency of dialysis is probably beneficial, but the results of powerful randomized, controlled trials should be awaited. Sodium profiling has more disadvantages than advantages, whereas potassium profiling mainly in arrhythmia-prone patients with ventricular hypertrophy should be considered. Intradialytic blood volume monitoring has reduced intradialytic hypotension episodes, but hard evidence for improving patient survival is lacking. Overall, the major technological advances in dialysis have not yet been translated into longer patient survival. Optimal predialysis care in preventing the cardiovascular damage that accumulates before the start of dialysis and timely creation of an arteriovenous fistula as vascular access is a more effective and more economic strategy in the long-term outcome of the dialysis patient.

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Haemodialysis with on-line monitoring equipment: tools or toys?

Cited by 115 publications

References 42 publications

Assessment of Hemodialysis Adequacy by Ionic Dialysance: Comparison to Standard Method of Urea Removal

Assessment of Hemodialysis Adequacy by Ionic Dialysance: Comparison to Standard Method of Urea Removal

Optical Dialysis Adequacy Monitoring: Small Uremic Toxins and Contribution to UV-Absorbance Studied by HPLC

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

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