Abstract
Background. Several reports describe favorable results from frequent hemodialysis, but due to the lack of unequivocal dose measures it is not clear whether the benefits are due to more efficient toxin removal or other factors. Methods. The associations with death risk of six continuous-equivalent urea clearance measures were compared in 57 conventional in-center hemodialysis treatment periods of 51 patients, together 114 patient years. The double pool dose measures were calculated with the Solute-Solver program and separately scaled to urea distribution volume or normalized with body surface area. Results. Mortality associated significantly with equivalent renal urea clearance (EKR) scaled to urea distribution volume (V) (p=0.033) and with EKR normalized with body surface area (BSA) (p=0.044) but not with V-scaled (p=0.059) nor BSA-normalized (p=0.183) standard clearance (stdK). Women had significantly higher normalized protein catabolic rate (nPCR), EKR/V, and stdK/V than men but slightly lower BSA-normalized dose measures and lower mortality. Protein catabolic rate and dialysis dose correlated positively with each other and with survival. Conclusions. The prognostically most valid continuous-equivalent clearance in the present material was EKR/V, calculated from double pool urea generation rate, distribution volume, and time-averaged concentration.
Highlights
Survival correlates with urea-based hemodialysis session dose in many large registry studies (Lowrie et al [1]: 43,334 patients, Port et al [2]: 84,936 patients, and Miller et al [3]: 88,153 patients) in conventional thrice-weekly schedule, but in the randomized controlled HEMO trial mean equilibrated Kt/V 1.53 did not result in a significantly better outcome than 1.16 [4].Intermittent hemodialysis treatments can be compared to each other by the session dose measures URR, Kt, Kt/V, and eKt/V only if the treatment frequency is equal
Linear regression analysis was used to evaluate the interaction of dialysis dose and normalized protein catabolic rate (nPCR) (Figure 1) and the material was split into two groups on the basis of EKR/V and nPCR (Table 3)
EKR/V was the only variable having an association with death risk (OR = 0.326, confidence intervals (CIs) = 0.117–0.912, and p = 0.033)
Summary
Survival correlates with urea-based hemodialysis session dose in many large registry studies (Lowrie et al [1]: 43,334 patients, Port et al [2]: 84,936 patients, and Miller et al [3]: 88,153 patients) in conventional thrice-weekly schedule, but in the randomized controlled HEMO trial mean equilibrated Kt/V (eKt/V) 1.53 did not result in a significantly better outcome than 1.16 [4].Intermittent hemodialysis treatments can be compared to each other by the session dose measures URR, Kt, Kt/V, and eKt/V only if the treatment frequency is equal. Urea distribution volume (V) is an essential variable in kinetic modeling and can be used as a representative of patient size, a scaling factor. It may have an independent effect on outcome [1, 8], which weakens the value of Kt/V as a prognostic factor. The double pool dose measures were calculated with the Solute-Solver program and separately scaled to urea distribution volume or normalized with body surface area. The prognostically most valid continuous-equivalent clearance in the present material was EKR/V, calculated from double pool urea generation rate, distribution volume, and time-averaged concentration
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
