Premium
Risk of Inadequate Dialysis Dose in Hemodialysis Patients with High Watson Volume. A Warning
Author(s) -
Cigarrán S.,
Coronel F.,
Torrente J.,
Sevilla M.,
Baylón J.C.D.
Publication year - 2004
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 - 10.1111/j.1492-7535.2004.0085o.x
Subject(s) - medicine , dialysis , hemodialysis , dialysis adequacy , kt/v , population , dialysis tubing , surgery , urology , environmental health , membrane , biology , genetics
Quality control of dialysis treatment has received wide attention since inadequate dialysis dose was an independent risk factor of morbidity and mortality in hemodialysis patients. Each 0.1 decrease in Kt/V less than 1.2 is estimated to increase the relative risk of death by 5–7%. A higher Kt/V can be achieved by increasing treatment time, using a larger dialyzer or increasing blood or dialysate flow rates. The aim of this cross‐sectional study was to know, using online conductivity monitor (OCM) routinely, whether a certain subgroup of patients is being treated inadequately. 24 anuric patients were included in a cross‐sectional study: 20.8% were diabetics, mean age 64.7 ± 18.2 years; 16% females. Access blood were AVFI and the effective dialyzed blood flow was set at 350 mL/min, with recirculation <5%. BMI was 25.4 ± 3.8 kg/m 2 and body weight was 69.7 ± 12 kg. All patients were dialyzed thrice weekly (245 ± 21 min) with dialysis machine 4008H (Fresenius Medical Care) equipped with OCM monitor and the hollow fiber high‐flux polysulfone membrane (HF‐80 1.8 m 2 ) and helixone (Fx‐60, 1.6 m 2 ). Dialysate flow was maintained at 500 mL/min, with standard dialysate liquid. Drug therapy was not varied. OCM was validated for our population and reported in other abstracts (r 2 = 0.96, p < 0.001). Inadequate dialysis dose was considered at OCM Kt/V less than 1.2. Data were processed and statistically analyzed with SPSS 11.0 software package. Watson volume (W v ) to other baseline characteristics was assessed by using contingency tables, t‐tests, analysis of variance, and linear regression, as appropriate. All the tests were performed for a 0.05 significance level. The OCM Kt/V weekly was inversely related to W v (r = −0.833, p < 0.001). 20.8% of our patients are at risk of inadequate dialysis dose, and it reflects our current practice of dialysis prescription. All of them are anuric young men with a W v > 40 L. Specific efforts are required to deliver an adequate dialysis dose in this kind of patients. This can be achieved by altering dialysis frequency, increasing membrane surface, and/or increasing dialysis flow. OCM Kt/V device permits a daily dialysis dose delivery and, consequently, an individualized prescription. Prospective studies are required to establish whether adequate dialysis dose in patients with W v > 40 L may further improve their survival.Variable n OCM Kt/V Age (year) THD (min) Watson volume (L)OCM Kt/V
<1.2 5 (20.8%) 1.05 ± 0.03 * 45.2 ± 12.91 * 240 ± 21.21 45.02 ± 3.03 * OCM Kt/V
≥1.2 19 (79.2%) 1.36 ± 0.17 69.89 ± 15.9 246 ± 21.21 34.6 ± 4.9* p < 0.001.