On-line urea kinetics in haemodiafiltration

Santoro, Antonio; Tetta, Ciro; Mandolfo, Salvatore; Arrigo, S.; Berti, M.; Colasanti, G.; D’Amico, Gianpiero; Imbasciati, E; Mazzocchi, Caterina; Pacini, Giovanni; Spongano, M.; Thomaseth, Karl; Wratten, Mary Lou; Zucchelli, P

doi:10.1093/ndt/11.6.1084

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…This mandate is justified by recent data [18][19][20][21][22][23][24][25] demonstrating a clear relationship between dialysis dose, as measured by Kt/V or urea reduction ratio and morbidity and mortality in HD patients. Until recently, there is only limited literature which addressed the issue dialysis adequacy in online high-flux HDF [5][6][7]. Mathematical modeling of urea kinetics and assessment of nutrition had so far been dependent upon urea measurements of blood or dialysate samples.…”

Section: Discussionmentioning

confidence: 99%

“…The validity of these assessment tools in the patients on on-line HDF is still unclear. Few clinical studies were conducted on this issue [4][5][6]. To circumvent these difficulties, and to more accurately quantify the efficacy of HDF, a modified direct dialysis quantification method (mDDQ) with direct measurement of the urea removed by total collection of dialysate has been advocated.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Pre- and Postdilutional On-Line Hemodiafiltration Adequacy by Partial Dialysate Quantification and On-Line Urea Monitor

et al. 1999

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On-line highflux hemodiafiltration (HDF) is a clinically interesting and effective mode of renal replacement therapy, which offers the possibility to obtain an increased removal of both small and large solutes. The fundamental role of urea kinetic monitoring to assess dialysis adequacy in conventional hemodialysis has been widely studied. Both direct measurement of the urea removed by the modified direct dialysate quantitation (mDDQ) based on partial dialysate collection (PDC) and dialysate-based urea kinetic modeling (DUKM) using urea monitor have been advocated. The validity of this assessment tool in the patients with on-line HDF remained unclear. The aims of this investigation were (1) to compare the delivered Kt/V, urea mass removal (UMR), solute removal index (SRI) and normalized protein catabolic rate (nPCR) between pre- and postdilutional high-flux HDF; (2) to verify and compare the efficiency of pre- and postdilutional HDF using DUKM with on-line dialysate urea sensor, and mDDQ with partial dialysate collection. During both mode of HDF, the paired analysis urea removed and Kt/V showed no significant difference. Using mDDQ, mean values for predilutional mode were as follows: Kt/V 1.53 ± 0.01 UMR, 16.8 ± 0.3 g/session; urea clearance 178 ± 18 ml/min; SRI 75.5 ± 7.7%; urea distribution volume (V) 28.3 ± 1.2 liters; nPCR 1.34 ± 0.18 g/kg/day; on the other hand, mean values for postdilutional mode were Kt/V 1.58 ± 0.01; UMR 17.10 ± 0.28 g/session; urea clearance 184 ± 21 ml/min; SRI 77.2 ± 3.5%; urea distribution volume, 27.8 ± 1.5 liters; nPCR 1.34 ± 0.19 g/kg/day. The mean value of urea generation rate was 5.82 ± 1.12 mg/min during HDF. Our results showed that dialysis adequacy was achieved with both high-volume predilutional HDF and postdilutional HDF. These two modes of HDF provided similar and adequate small solute clearance. In addition, we found that on-line analysis of urea kinetics is a reliable tool for quantifying and assuring delivery of adequate dialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Pre- and Postdilutional On-Line Hemodiafiltration Adequacy by Partial Dialysate Quantification and On-Line Urea Monitor

et al. 1999

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“…Kada se započne neprekidno praćenje klirensa, nakon postizanja stabilne provodljivosti, modul uspostavlja mjerne cikluse u pravilnim intervalima, a sabiranjem dobijenih vrijednosti dobija se kumulativna vrijednost indeksa Kt/V, koja predstavlja stvarnu količinu isporučene doze dijalize izmjerene ovim indeksom. Ovdje vrijednost К predstavlja in vivo klirens dijalizatora koji se dobije pri zadatim uslovima [8,[18][19][20][21][22].…”

Section: Mjerenje Dijalizibilnosti Jonaunclassified

Improvement of hemodialysis quality by application of various models for adequacy aseessment

Vlatković¹

2004

Scripta Medica

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Sažetak. Napori za poboljšanjem kvaliteta hemodijalize i liječenja dijaliznih bolesnika, dovela su do razvijanja različitih modela rada i kontrole. Kontinuirano unapređenje kvaliteta je interni procès koji je neophodan da Ы se pokrenuli svi segmenti ka podizanju nivoa kvaliteta brige i liječenja. Sistem unapredenja kvaliteta mora biti jasan, zasnovan na čvrstoj osnovi, široko rasprostranjen i dobro kontrolisan.

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“…Online HDF provides the largest amount of purifi ed blood over a wide molecular weight spectrum achievable with present renal replacement therapies. Actually, online HDF seems to offer an optimal form of dialysis, particularly when used in patients with cardiovascular instability [5,6] . However, objectively, it is not always possible to have absolute certainty concerning the sterility and pyrogen-free status of the reinfusion fl uids thus obtained.…”

mentioning

confidence: 99%

One Year of Clinical Experience in Postdilution Hemofiltration with Online Reinfusion of Regenerated Ultrafiltrate

et al. 2004

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Background/Aims: Hemofiltrate reinfusion (HFR) is characterized by the use of regenerated ultrafiltrate as replacement fluid. We set up a new technique, postdilution HFR (PD-HFR), aiming at increasing purification efficiency, treatment tolerance and at reducing inflammatory states. Methods: We performed PD-HFR in 6 uremic patients during 1 year. Dialysis efficacy, dialyzer blood loss and the behavior of cytokines were evaluated. Results: No pyrogenic reactions or other adverse events were recorded. Treatment tolerance was excellent. We observed high urea extraction rates and optimal Kt/V values, high β₂-microglobulin (β₂m) extraction rates and a decrease in dialyzer blood loss; also IL-6 and TNF-α decreased significantly. Conclusions: Inversion of the standard HFR configuration has allowed us to improve the removal of both urea and β₂m, and to decrease dialyzer blood loss, with an optimal tolerance. Moreover, the decrease in cytokine levels might attenuate the uremic microinflammatory state.

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On-line urea kinetics in haemodiafiltration

Abstract: These results indicate that on-line, real-time analysis of urea kinetics may provide information on delivery of adequate dialysis in high-efficiency techniques.

Cited by 9 publications

References 18 publications

Evaluation of Pre- and Postdilutional On-Line Hemodiafiltration Adequacy by Partial Dialysate Quantification and On-Line Urea Monitor

Evaluation of Pre- and Postdilutional On-Line Hemodiafiltration Adequacy by Partial Dialysate Quantification and On-Line Urea Monitor

Improvement of hemodialysis quality by application of various models for adequacy aseessment

One Year of Clinical Experience in Postdilution Hemofiltration with Online Reinfusion of Regenerated Ultrafiltrate

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