Urea rebound and effectively delivered dialysis dose

Alloatti, S; Molino, Andrea; Mañes, M; Bosticardo, Gianmario

doi:10.1093/ndt/13.suppl_6.25

Cited by 16 publications

(12 citation statements)

References 22 publications

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“…One of them was that proposed by Smye et al [2], which is a formula based on the constant-volume compartment model with the compartments arranged in series. The Smye proposed formula is the following: eqU = U pre W e -·THD (1) where · = 1…”

Section: Estimation Of the Equmentioning

confidence: 99%

“…The estimation of the equilibrated postdialysis blood urea concentration (eqU) during the dialysis session has become an important subject of research in nephrology because of its influence on the calculation of the true dialysis dose achieved in a patient [1].…”

Section: Introductionmentioning

confidence: 99%

“…This phenomenon is called urea rebound (UR) and can be explained in terms of recirculation and U sequestration in different body compartments [1][2][3]. UR is a critical problem, which influences the calculation of eqU thus increasing the risk of malestimation of the true dose of dialysis [1].…”

Section: Introductionmentioning

confidence: 99%

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Using Artificial Intelligence to Predict the Equilibrated Postdialysis Blood Urea Concentration

Fernández

Valtuille²,

Willshaw³

et al. 2001

Blood Purif

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Total dialysis dose (Kt/V) is considered to be a major determinant of morbidity and mortality in hemodialyzed patients. The continuous growth of the blood urea concentration over the 30- to 60-min period following dialysis, a phenomenon known as urea rebound, is a critical factor in determining the true dose of hemodialysis. The misestimation of the equilibrated (true) postdialysis blood urea or equilibrated Kt/V results in an inadequate hemodialysis prescription, with predictably poor clinical outcomes for the patients. The estimation of the equilibrated postdialysis blood urea (eqU) is therefore crucial in order to estimate the equilibrated (true) Kt/V. In this work we propose a supervised neural network to predict the eqU at 60 min after the end of hemodialysis. The use of this model is new in this field and is shown to be better than the currently accepted methods (Smye for eqU and Daugirdas for eqKt/V). With this approach we achieve a mean difference error of 0.22 ± 7.71 mg/ml (mean % error: 1.88 ± 13.46) on the eqU prediction and a mean difference error for eqKt/V of –0.01 ± 0.15 (mean % error: –0.95 ± 14.73). The equilibrated Kt/V estimated with the eqU calculated using the Smye formula is not appropriate because it showed a great dispersion. The Daugirdas double-pool Kt/V estimation formula appeared to be accurate and in agreement with the results of the HEMO study.

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Section: Estimation Of the Equmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using Artificial Intelligence to Predict the Equilibrated Postdialysis Blood Urea Concentration

Fernández

Valtuille²,

Willshaw³

et al. 2001

Blood Purif

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“…However, to the best of our knowledge, data concerning the kinetics of plasma cytokines after hemodialysis in sepsis patients with AKI are dramatically lacking. In patients with chronic renal failure, IRRT is followed by a fast but mild increase in serum urea or potassium levels during the first hour ("rebound" phenomenon) [16,17]. Similarly, given the high level of cytokine production in septic tissues, plasma cytokine levels may dramatically vary after IRRT.…”

Section: Introductionmentioning

confidence: 99%

Kinetics of plasmatic cytokines and cystatin C during and after hemodialysis in septic shock-related acute renal failure

et al. 2010

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IntroductionCystatin C could be a relevant residual glomerular filtration rate marker during hemodialysis (HD), and a high cytokine plasma (p) rate is associated with an increase in mortality during sepsis. To the best of our knowledge, cytokines and cystatin C kinetics during and after HD during sepsis have never been studied. In this study, we described p cytokines and cystatin C variations during and after hemodialysis in septic-shock patients with acute kidney injury (AKI).MethodsTen patients, from two tertiary ICUs, with septic shock-related AKI, according to RIFLE class F, were studied. In this prospective observational study, blood samples were collected at the start, after 1 hour, 2 hours, and at the end of HD with a polymethymethacrylate (PMMA) hemodialyzer (D0, D1, D2, and endD), and 30, 60, 90, 120, and 180 min after HD (postD0.5, postD1, postD1.5, postD2, and postD3). We measured p interleukins (IL)-6, IL-8, IL-10, cystatin C, and albumin. Results are expressed as variations from D0 (mean ± SD).ResultsDuring HD, p[IL-6] did not vary significantly, whereas p[IL-8] and p[IL-10] reductions by D1 were 31.8 ± 21.2% and 36.3 ± 26%, respectively (P < 0.05 as compared with D0). At postD3, p[IL-8] and p[IL-10] returned to their initial values. p[Cystatin C] was significantly reduced from D1 to postD1, with a maximal reduction of 30 ± 6.7% on D2 (P < 0.05). Norepinephrine infusion rate decreased from D0 to postD3 (0.65 ± 0.39 to 0.49 ± 0.37 μg/kg/min; P < 0.05).ConclusionsHD allows a transient and selective decrease in p cytokines, which are known as being correlated with mortality during septic shock. Because of a significant decrease in p cystatin C during HD, this should not be considered as an accurate marker for residual glomerular filtration rate during septic acute renal failure when receiving HD with a PMMA hemodialyzer.

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“…Equally, for individuals with compromised renal function who are regularly undergoing hemodialysis, reliable pre-and post-treatment measurements, as well as in situ monitoring, during dialysis, would be beneficial (11), reducing the risk of infection and anaemia (12,13). The potential to follow urea essentially continuously, furthermore, may reduce errors from urea rebound at the end of dialysis (14,15), allow systematic observations of the patient_s status to be made (to avoid empiricism (16)), and to get accurate post-dialysis BUN (15,17,18).…”

Section: Introductionmentioning

confidence: 99%

Monitoring of Urea and Potassium by Reverse Iontophoresis In Vitro

et al. 2007

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Purpose. Reverse iontophoresis is an alternative to blood sampling for the monitoring of endogenous molecules. Here, the potential of the technique to measure urea and potassium levels non-invasively, and to track their concentrations during hemodialysis, has been examined. Materials and Methods. In vitro experiments were performed to test (a) a series of subdermal urea and potassium concentrations typical of the pathophysiologic range, and (b) a decreasing profile of urea and potassium subdermal concentrations to mimic those which are observed during hemodialysis. Results. (a) After 60Y120 min of iontophoresis, linear relationships (p<0.05) were established between both urea and potassium fluxes and their respective subdermal concentrations. The determination coefficients were above 0.9 after 1 h of current passage using sodium as an internal standard. (b) Reverse iontophoretic fluxes of urea and K + closely paralleled the decay of the respective concentrations in the subdermal compartment, as would occur during a hemodialysis session. Conclusions. These in vitro experiments demonstrate that urea and potassium can be quantitatively and proportionately extracted by reverse iontophoresis, even when the subdermal concentrations of the analytes are varying with time. These results suggest the non-invasive monitoring of urea and potassium to diagnose renal failure and during hemodialysis is feasible, and that in vivo measurements are warranted.

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Urea rebound and effectively delivered dialysis dose

Cited by 16 publications

References 22 publications

Using Artificial Intelligence to Predict the Equilibrated Postdialysis Blood Urea Concentration

Using Artificial Intelligence to Predict the Equilibrated Postdialysis Blood Urea Concentration

Kinetics of plasmatic cytokines and cystatin C during and after hemodialysis in septic shock-related acute renal failure

Monitoring of Urea and Potassium by Reverse Iontophoresis In Vitro

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