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      Assessment of the Length of Each Hemodialysis Session by On-Line Dialysate Urea Monitoring

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          Abstract

          Hemodialysis (HD) prescription is usually based on the periodical measurement of the Kt/V achieved in a midweek dialysis session. The purpose of the study was to assess the duration of each HD session to achieve a target dose of dialysis. This allowed to determine whether a given dialysis session may be considered representative of the other HD sessions. Seventy-two HD sessions were studied in 4 stable patients, who were randomly dialyzed during 3 consecutive periods, each lasting 2 weeks, using a different blood flow rate (Qb) in each period: 400, 300 or 200 ml/min. All HD were prolonged to achieve an on-line dialysate urea monitor (UM) Kt/V of 1.2. The UM Kt/V was compared with the Kt/V calculated using pre-HD, post-HD and rebound (45 min post-HD) plasma water urea concentrations. Comparison of the duration of the second midweek dialysis session with the length of the other HD showed 95% concordance intervals (±2 SD) of ±21.08 min for Qb 400, ±26.88 min for Qb 300 and ±37.02 min for Qb 200 ml/min. The 95% concordance intervals for whole body urea clearance were ±32.0, ±20.36 and ±15.62 ml/min for Qb 400, 300 and 200 ml/min, respectively. No differences were observed between UM Kt/V and blood-based double-pool Kt/V obtained by the second-generation Daugirdas (1.18 ± 0.08) and Garred (1.19 ± 0.08) Kt/V formulas. In conclusion, a great variability was observed between different HD sessions with regard to the whole body urea clearance and the time required to attain a target Kt/V even when the HD characteristics remained constant. The length of every HD required to achieve a target dose of dialysis can be assessed by on-line dialysate urea monitoring.

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          The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis.

          Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis. We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration. As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of death during follow-up (odds ratio, 1.28 for urea reduction ratios of 55 to 59 percent and 1.39 for ratios below 55 percent). Fifty-five percent of the patients had urea reduction ratios below 60 percent. The duration of dialysis was not predictive of mortality. The serum albumin concentration was a more powerful (21 times greater) predictor of death than the urea reduction ratio, and 60 percent of the patients had serum albumin concentrations predictive of an increased risk of death (values below 4.0 g per deciliter). The odds ratio for death was 1.48 for serum albumin concentrations of 3.5 to 3.9 g per deciliter and 3.13 for concentrations of 3.0 to 3.4 g per deciliter. Diabetic patients had lower serum albumin concentrations and urea reduction ratios than nondiabetic patients. Low urea reduction ratios during dialysis are associated with increased odds ratios for death. These risks are worsened by inadequate nutrition.
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            Author and article information

            Journal
            NEF
            Nephron
            10.1159/issn.1660-8151
            Nephron
            S. Karger AG
            1660-8151
            2235-3186
            2001
            2001
            24 August 2001
            : 89
            : 1
            : 37-42
            Affiliations
            Department of Nephrology, Reina Sofia University Hospital, Cordoba, Spain
            Article
            46041 Nephron 2001;89:37–42
            10.1159/000046041
            11528230
            © 2001 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 2, Tables: 2, References: 26, Pages: 6
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/46041
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            Original Paper

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