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      Daily Dialysis: The Long and the Short of It


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          There is considerable enthusiasm for daily hemodialysis despite the increased time commitment required of patients because of reported improvements in patient well-being, appetite and blood pressure control. To date, this therapy has been largely empirical and has been defined primarily by treatment time (t) and categorized as short daily hemodialysis (SDHD) with t about 2 h and long nocturnal hemodialysis (LNHD) with t 8–9 h. It is the authors’ view that studies comparing clinical outcome with SDHD and LNHD to conventional hemodialysis (CHD) must have dialysis dosage well defined if they are to provide generalizable results. There is a broad range and overlap in the magnitude of solute removal in reported studies of SDHD, LNHD and CHD, which is illustrated here through kinetic consideration of four solutes: (1) urea; (2) inorganic phosphorus (iP); (3) β<sub>2</sub>-microglobulin (β<sub>2</sub>M) and (4) Na/water. The following observations can be made: (1) Patient subjective reports of increased appetite and protein intake may correlate poorly with kinetic calculation of protein catabolic rate. (2) A model of iP mass balance was developed and indicates that iP removal with CHD is inadequate; current SDHD is also inadequate to highly excessive depending on the dose of dialysis. (3) β<sub>2</sub>M removal with SDHD is virtually the same as reported for LNHD, reflecting major differences in dialyzer membranes used. (4) The decrease in predialysis overhydration is a predictable function of the number of dialyses per week and may be one of the most important benefits of more frequent dialysis. (5) The standard K<sub>t</sub>/V (stdK<sub>t</sub>/V) provides a uniform method of dose calculation but the therapy prescription should also include consideration of the other solutes evaluated above.

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          Kt/V Is the Best Dialysis Dose Parameter

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            Is Kt/V Urea a Satisfactory Measure for Dosing the Newer Dialysis Regimens?


              Author and article information

              Blood Purif
              Blood Purification
              S. Karger AG
              29 August 2003
              : 21
              : 4-5
              : 271-281
              aUniversity of California San Francisco, San Francisco, Calif., and bRenal Research Institute, New York, N.Y., USA
              72545 Blood Purif 2003;21:271–281
              © 2003 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.

              : 20 May 2003
              Page count
              Figures: 18, References: 15, Pages: 11
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/72545
              Self URI (text/html): https://www.karger.com/Article/FullText/72545
              Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
              Original Paper

              Cardiovascular Medicine,Nephrology
              β2-Microglobulin,Phosphorus,Urea,Fluid overload,Daily dialysis,Kinetic modeling,Standard Kt/V


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