Moving Away From Measuring Serum Urea Nitrogen to Estimate Dialyzer Urea Clearance: Technological Panacea or Curio?

Davenport, Andrew

doi:10.1053/j.ajkd.2020.01.017

American Journal of Kidney Diseases

2020

DOI: 10.1053/j.ajkd.2020.01.017

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Moving Away From Measuring Serum Urea Nitrogen to Estimate Dialyzer Urea Clearance: Technological Panacea or Curio?

Andrew Davenport¹

Abstract: O ne of the aims of maintenance dialysis is to clear waste products of metabolism that would otherwise accumulate. In the 1970s, the National Cooperative Dialysis Study (NCDS) reported that patients with a

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2024

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Cited by 2 publications

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Development and Evaluation of User‐Friendly Modeled Approach for Sustainable Polymer Membranes for Advanced Hemodialysis

Khan,

Jahan,

Ahsan

et al. 2024

Adv Materials Inter

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Hemodialysis is crucial for patients with end‐stage renal disease, yet evaluating its operating parameters often requires complex mathematical models. To simplify this process, user‐friendly modules have been developed to accurately assess key parameters with minimal inputs, enabling users to track disease prognosis. These modules incorporate governing equations and allow straightforward analysis. Validation against experimental data from polymer membrane studies demonstrated that at a blood flow rate of 300 mL min−1, the model predicted a clearance of 262 mL min−1, showing 7% difference from the actual value of 281 mL min−1. At a dialysate flow of 400 mL min−1, the model's predicted clearance was 286.47 mL min−1, with only a 1% difference compared to previous model. The module also showed 40% higher clearance in counter‐current flow compared to co‐current, with a 47% difference at 400 mL min−1 dialysate flow. Increasing the hollow fibre length from 27 to 50 cm led to a 4% clearance increase. Additionally, increasing residual renal clearance by 0.5 mL min−1 doubled the standard Kt V−1 Kt/V, and similar effects were seen by increasing weekly hemodialysis sessions. The app allows simulations, plots, and comparisons with minimal inputs and can be integrated into MATLAB or other platforms, benefiting both patients and researchers in prognosis and treatment analysis.

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Development and Evaluation of User‐Friendly Modeled Approach for Sustainable Polymer Membranes for Advanced Hemodialysis

Khan,

Jahan,

Ahsan

et al. 2024

Adv Materials Inter

View full text Add to dashboard Cite

show abstract

Comparison of hemodialysis urea clearance using spent dialysate and Kt/Vurea equations

Khatri,

Davenport

2024

Artificial Organs

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IntroductionDialysis adequacy is traditionally calculated from pre‐ and post‐hemodialysis session serum urea concentrations and expressed as the urea reduction ratio, or Kt/Vurea. However, with increasing hemodiafiltration usage, we wished to determine whether there were any differences between standard Kt/Vurea equations and directly measured spent dialysate urea clearance.MethodsUrea clearance was measured from collected effluent dialysate and compared with various other methods of Kt/Vurea calculation, including change in total body urea from measuring pre‐ and post‐total body water with bioimpedance and the Watson equation, by standard Kt/V equations, and online clearance measurements using effective ionic dialysance (OLC).ResultsWe compared urea clearance in 41 patients, 56.1% male, mean age 69.3 ± 12.6 years with 87.8% treated by hemodiafiltration. Reduction in total body urea was greater when estimating changes in total body urea, compared to measured dialysate losses of 58.4% (48.5–67.6) vs 71.6% (62.1–78), p < 0.01. Sessional urea clearance (Kt/Vurea) was greater using the online Solute‐Solver program compared to OLC, median 1.45(1.13–1.75) vs 1.2 (0.93–1.4), and 2nd generation Kt/V equations 1.3 (1.02–1.66), p < 0.01, but not different from estimated total body urea clearance 1.36 (1.15–1.73) and dialysate clearance 1.36 (1.07–1.76). The mean bias compared to the Solute‐Solver program was greatest with OLC (−0.25), compared to second‐generation equations (−0.02), estimated total body clearance (−0.02) and measured dialysate clearance (−0.01).ConclusionThis study demonstrated that the result from equations estimating urea clearance indirectly from pre‐ and postblood samples from hemo‐ and hemodiafiltration treatments was highly correlated with direct measurements of dialysate urea clearance.

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Moving Away From Measuring Serum Urea Nitrogen to Estimate Dialyzer Urea Clearance: Technological Panacea or Curio?

Abstract: O ne of the aims of maintenance dialysis is to clear waste products of metabolism that would otherwise accumulate. In the 1970s, the National Cooperative Dialysis Study (NCDS) reported that patients with a

Cited by 2 publications

References 13 publications

Development and Evaluation of User‐Friendly Modeled Approach for Sustainable Polymer Membranes for Advanced Hemodialysis

Development and Evaluation of User‐Friendly Modeled Approach for Sustainable Polymer Membranes for Advanced Hemodialysis

Comparison of hemodialysis urea clearance using spent dialysate and Kt/Vurea equations

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