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      Fractional Solute Removal and KT/V in Different Modalities of Renal Replacement Therapy

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          Abstract

          The efficacy of solute removal by renal replacement therapy can be assessed by the commonly used index of KT/V (the fraction of the volume cleared from a solute). Fractional solute removal (FSR, the fraction of the total amount of the solute that was removed) is an alternative index that may be more appropriate than KT/V for comparison of the efficacy of different treatment modalities. To elucidate the relationship between these two indexes, we propose to discriminate between two notions of clearance: (1) instantaneous clearance K = (solute removal rate)/C<sub>B</sub>, where C<sub>B</sub> is solute concentration in blood, and (2) treatment clearance K<sub>T</sub> = (average rate of solute removal per treatment)/C<sub>B0</sub>, where C<sub>B0</sub> is C<sub>B</sub> at the beginning of the treatment. K is the clearance of the purification device (glomeruli, hemodialyzer or hemofilter) and the diffusive mass transport parameter (K<sub>BD</sub>, MTAC) for continuous ambulatory peritoneal dialysis (CAPD). For all modalities of renal replacement therapy: FSR = K<sub>T</sub>T/V, and K<sub>T</sub> generally decreases with the treatment time. For purification of a single compartment with a constant volume, V, using an open loop system (i.e. with no recirculation or dwelling of dialysis fluid, as in hemodialysis (HD), hemofiltration (HF) or in the native kidney), FSR is a function of only one lumped, nondimensional parameter, KT/V<sub>B</sub>, where V<sub>B</sub> is the distribution volume of the solute within the body. In contrast, if closed loop systems are applied, as for example in HD with recirculation of dialysis fluid (RD) or in peritoneal dialysis, FSR depends on two lumped, nondimensional parameters: KT/V<sub>B</sub> and KT/V<sub>D</sub>, where V<sub>D</sub> is the volume of dialysis fluid. It is necessary to discriminate between K and K<sub>T</sub> for analysis of dialysis dose. For HD and HF, FSR is a function of KT/V, whereas KT/V alone does not allow calculation of FSR for CAPD and RD. The current practice of using K<sub>T</sub>T/V for CAPD but KT/V for HD and HF leads to confusion because of the inconsistency in the interpretation of the quantitative prescription of dialysis dose. The application of FSR, instead of KT/V, for all treatment modalities may solve this dilemma. Furthermore, K<sub>T</sub>T/V (currently used only for CAPD) is equal to FSR for all treatment modalities. Both FSR and K<sub>T</sub> may be generalized to describe the total solute removal per treatment cycle composed from a few treatment sessions. A few different definitions of the adequacy parameters for the treatment cycle are formulated and discussed.

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          Most cited references 14

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          Kt/V Is the Best Dialysis Dose Parameter

           Frank Gotch (2000)
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            • Abstract: not found
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            Compartment Effects in Hemodialysis

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              • Abstract: not found
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              Quantification of Middle Molecular Weight Solute Removal in Dialysis

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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
                2004
                June 2004
                02 September 2004
                : 22
                : 4
                : 367-376
                Affiliations
                aDivisions of Baxter Novum and Renal Medicine, Karolinska Institute, Stockholm, Sweden, and bInstitute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
                Article
                80033 Blood Purif 2004;22:367–376
                10.1159/000080033
                15297787
                © 2004 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: 4, References: 22, Pages: 10
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/80033
                Categories
                Review Article

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