Improved equation for estimating single-pool Kt/V at higher dialysis frequencies

Daugirdas, John T.; Leypoldt, John K.; Akonur, Alp; Greene, Tom; Depner, Thomas A.

doi:10.1093/ndt/gfs115

Cited by 46 publications

(32 citation statements)

References 13 publications

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“…Dialysis dose, KRU, weekly percentage interdialytic weight gain (IDWG), and normalized protein catabolic rate (nPCR) was calculated by using urea kinetic modeling equations (see Item S1 for details). 1,36-41 …”

Section: Methodsmentioning

confidence: 99%

Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

Obi

Streja

Rhee

et al. 2016

American Journal of Kidney Diseases

204

217

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Background Maintenance hemodialysis is typically prescribed thrice-weekly irrespective of patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. Study Design A longitudinal cohort Setting & Participants 23,645 patients who initiated maintenance hemodialysis in a large dialysis organization in the United States (1/2007–12/2010), who had available RKF data during the first 91 days (or quarter) of dialysis, and who survived the first year. Predictor Incremental (routine twice-weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice-weekly) hemodialysis regimens during the same time. Outcomes Changes in renal urea clearance (KRU) and urine volume (UV) during one year after the first quarter, and survival after the first year. Results Among 23,645 included patients, 51% had substantial KRU (≥3.0 mL/min/1.73m2) at baseline. Compared to 8,068 patients with conventional hemodialysis regimen matched based on baseline KRU, UV, age, gender, diabetes, and central venous catheter use, 351 patients with incremental regimen exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved KRU and UV at second quarter, respectively, which remained across the following quarters. Incremental regimen showed higher mortality risk in patients with inadequate baseline KRU (≤3.0 mL/min/1.73m2; HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline KRU (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in subgroup defined by baseline UV of 600 mL/day. Limitations Potential selection bias and wide CIs. Conclusions Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and associated with greater preservation of RKF while higher mortality is observed after a year in those with lowest RKF. Clinical trials are needed to examine safety and effectiveness of twice-weekly hemodialysis.

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Section: Methodsmentioning

confidence: 99%

Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

Obi

Streja

Rhee

et al. 2016

American Journal of Kidney Diseases

204

217

View full text Add to dashboard Cite

show abstract

“…We calculated dialysis dose and residual renal CL urea assuming the average serum urea concentrations during the collection to be 90% of the predialysis concentrations according to the Daugirdas approach as follows [33][34][35] Renal CL urea ðml=minÞ ¼ urinary urea ðmg=dlÞ Â urinary volume ðmlÞ collected time ðminÞ Â ½0:9 Â serum urea ðmg=dlÞ…”

Section: Demographic Clinical and Laboratory Measuresmentioning

confidence: 99%

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

Mathew

Obi

Rhee

et al. 2016

Kidney International

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“…We used the Daugirdas equation [5] for spKt/V and Leypoldt equation [6] for stdKt/V calculation. High-dose group then received dialysis prescription intervention, determined by experienced nephrologists in each center, to achieve target spKt/V over 1.70 per session.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Value of the Delivery Dialysis Dose on Twice-Weekly Hemodialysis Patients

Fan

Yan²,

Gu³

et al. 2017

Am J Nephrol

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Background: Few studies have evaluated the prognostic value of dialysis dose in twice-weekly hemodialysis (HD). A single-pool Kt/V (spKt/V) over 1.70 may benefit patients receiving twice-weekly maintenance HD. Methods: This is a multicenter randomized controlled trial performed on 163 patients from 17 dialysis centers in Shanghai who were allocated to high- (n = 98) and standard-dose groups (n = 65) and followed through 96 weeks of study period. Therapeutic approaches were given to increase spKt/V to over 1.70 in the high-dose group. Data were collected every 12-24 weeks. The primary outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACEs) occurrence, and secondary outcomes included residual kidney function (RKF) and health-related quality of life (HR-QOL). Results: The spKt/V in high-dose and standard-dose groups were 1.80 ± 0.23 and 1.55 ± 0.19, respectively, after an 8-week intervention (p < 0.001). At the end of the study, SF-36 physical function and total score in high-dose group were 82 (69-90) and 74 (47-84), respectively, both of which were higher than those in the standard-dose group. Decline in urine volume was observed in both groups with no significant difference (p = 0.431). No difference was found in overall survival between the 2 groups (p = 0.580). The 1-year MACE-free survival for high-dose group was 84.49%, better than 76.72% for standard-dose group (p = 0.029). Conclusions: Higher spKt/V is also associated with MACE-free survival and better HR-QOL, especially in physical function aspect for twice-weekly dialysis patients. Increasing spKt/V over 1.70 in twice-weekly HD population does not cause loss of RKF.

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Improved equation for estimating single-pool Kt/V at higher dialysis frequencies

Abstract: For frequent dialysis schedules, the urea generation factor (GFAC) of one commonly used Kt/V prediction equation should be adjusted based on length in days of the PIDI and number of treatments per week.

Cited by 46 publications

References 13 publications

Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

Prognostic Value of the Delivery Dialysis Dose on Twice-Weekly Hemodialysis Patients

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