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A swan song for Kt/V urea
Author(s) -
Vanholder Raymond,
Van Biesen Wim,
Lameire Norbert
Publication year - 2019
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12811
Subject(s) - medicine , kt/v , dialysis , dialysis adequacy , nephrology , hemodialysis , urea , intensive care medicine , urology , ultrafiltration (renal) , renal function , randomized controlled trial , albumin , biochemistry , chemistry
Dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume (Kt/V urea or simply Kt/V) has been used as an index of dialysis adequacy since more than 30 years. This article reviews the flaws of Kt/V, starting with a lack of proof of concept in three randomized controlled hard outcome trials (RCTs), and continuing with a long list of conditions where the concept of Kt/V was shown to be flawed. This information leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete. The dialysis patient might benefit more if, instead, the nephrology community concentrates in the future on pursuing the optimal dialysis dose that conforms with adequate quality of life and on factors that are likely to affect outcomes more than Kt/V. These include residual renal function, volume status, dialysis length, ultrafiltration rate, the number of intra‐dialytic hypotensive episodes, interdialytic blood pressure, serum potassium and phosphate, serum albumin, and C reactive protein.