Premium
Adequacy of Daily Hemofiltration (HF): Clinical Evaluation of Standard Kt/V
Author(s) -
Jaber B.L.,
Zimmerman D.L.,
Leypoldt J.K.
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01217.x
Subject(s) - kt/v , hemofiltration , medicine , urea , volume (thermodynamics) , nuclear medicine , urology , zoology , surgery , hemodialysis , chemistry , biochemistry , physics , biology , quantum mechanics
Standard Kt/V (stdKt/V) has been proposed as a dose measure for daily therapies (adequate therapy defined as stdKt/V ≥ 2.0), but this parameter is difficult to evaluate without determining equilibrated Kt/V (eKt/V). We determined eKt/V in 34 urea kinetic modeling (UKM) sessions from 13 patients undergoing daily HF (6 times/wk) in 2 different centers with a single‐pool Kt/V (spKt/V) goal of 0.40. The patient characteristics were as follows: age 55 ± 19 (SD) years; 9 males; 3 diabetics; and dry weight 71.1 ± 14.4 kg. Urea concentration was measured pre‐HF, and 0 and 60 min post‐HF. spKt/V and eKt/V were calculated using the 0‐ and 60‐min post‐HF urea concentrations, respectively, and eKt/V was corrected for urea generation post‐HF. eKt/V was also predicted from spKt/V using the Daugirdas‐Schneditz (DS) rate equation. stdKt/V was calculated using the Gotch fixed‐volume kinetic model equation. Results:Treatment and UKM parameters Mean ± SDTreatment time, hour 2.32 ± 0.68 Blood flow rate, ml/min 485 ± 23 Replacement fluid volume, L 12.7 ± 2.1 Net volume removed, L 1.1 ± 0.8 Measured spKt/V 0.441 ± 0.041 Measured eKt/V 0.388 ± 0.063* Predicted eKt/V 0.350 ± 0.047 stdKt/V, per week 1.95 ± 0.26 Measured eKt/V was greater than that predicted (*p < 0.001).We conclude that 1) the DS rate equation cannot be used to accurately predict eKt/V during daily HF and 2) daily HF with an exchange (replacement plus removed) volume of 20% of body weight (13.8 L/71.1 kg = 19.4%) delivers a weekly stdKt/V of ∼ 2.0.