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      Analysis of Urea Nitrogen and Creatinine Kinetics in Hemodialysis: Comparison of a Variable-Volume Two-Compartment Model with a Regional Blood Flow Model and Investigation of an Appropriate Solute Kinetics Model for Clinical Application

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          Abstract

          To investigate an appropriate solute kinetics model for clinical application, we analyzed urea nitrogen (UN) and creatinine (Cr) kinetics by a variable-volume two-compartmental model (2CM) and a regional blood flow model (RBF) in 44 hemodialysis patients with varying proportions of first compartmental volume and regional volume (p<sub>1</sub>). Solute kinetics could not be solved in some of the patients with higher p<sub>1</sub> values, and there were more solution failures by the RBF than by the 2CM. The solute generation rate (g) and solute distribution volume in the dry state (V<sub>D</sub>) increased with increases in p<sub>1</sub> in both models, but there were some differences between the two models. When g was normalized by V<sub>D</sub>, it became relatively constant, irrespective of the p<sub>1</sub> value or model used (0.133 ± 0.029 mg/min/l by the 2CM and 0.132 ± 0.029 mg/min/l by the RBF for UN; 0.0200 ± 0.0049 mg/min/l by the 2CM and 0.0198 ± 0.0048 mg/min/l by the RBF for Cr). The intercompartmental mass transfer coefficient (K<sub>c</sub>; liters/min) calculated by the 2CM decreased as p<sub>1</sub> increased (K<sub>c</sub> = –1.77·p<sub>1</sub> + 1.16, p < 0.0001, R = 0.999 for UN; K<sub>c</sub> = –0.847·p<sub>1</sub> + 0.556, p < 0.0001, R = 1.000 for Cr). The systemic blood flow (Q<sub>sys</sub>; liters/min) calculated by the RBF also decreased as p<sub>1</sub> increased (Q<sub>sys</sub> = –11.1·p<sub>1</sub> + 6.21, p < 0.0005, R = 1.000 for UN; Q<sub>sys</sub> = –5.22·p<sub>1</sub> + 2.90, p < 0.001, R = 0.999 for Cr). Since the RBF more frequently failed to solve the solute kinetics and since there was a difference in its Q<sub>sys</sub> values for UN and Cr, the 2CM was considered to be a superior model. When p<sub>1</sub> was extremely low, the 2CM could be transformed into a modified variable-volume one-compartment model (1CM) which presented a similar g/V<sub>D</sub> (0.133 ± 0.029 for UN; 0.0200 ± 0.0048 for Cr). This modified 1CM was considered to satisfy appropriate conditions for clinical application, since it is simpler than the 2CM and provides useful information on the dialysis dose.

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          Author and article information

          Journal
          BPU
          Blood Purif
          10.1159/issn.0253-5068
          Blood Purification
          S. Karger AG
          0253-5068
          1421-9735
          2000
          2000
          23 February 2000
          : 18
          : 1
          : 18-29
          Affiliations
          aShakai-Hoken Mishima Hospital, Mishima City, Shizuoka and bTokyo Medical and Dental University, Tokyo, Japan
          Article
          14404 Blood Purif 2000;18:18–29
          10.1159/000014404
          10686439
          38f62a4f-ee53-49c8-a26a-aaec68b1bad8
          © 2000 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.

          History
          Page count
          Figures: 6, Tables: 5, References: 31, Pages: 12
          Categories
          Original Paper

          Cardiovascular Medicine,Nephrology
          Hemodialysis,Solute kinetics,Dialysis dose,Urea nitrogen,Creatinine,Variable-volume two-compartment model,Regional blood flow model,Blood recirculation,Solute disequilibrium

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