A New Approach to Optimizing Urea Clearances in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis

Kd, Nolph; Keshaviah, Prakash; Emerson, Paul F.; Jc, Van Stone; Zj, Twardowski; Khanna, Ramesh; Moore, Harold L.; Collins, Allan J.; Edward, A.

doi:10.1097/00002480-199507000-00049

Cited by 14 publications

(5 citation statements)

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“…This fact was subsequently confirmed in a longitudinal analysis of the same cohort of patients (27), wherein when Kt/V > 2.0, more than 86% of patients were consuming more than 0.8 g/kg/day of protein, but when Kt/V was <2.0, 66% were ingesting less than 0.8 g/kg/day of protein. These studies are consistent with the view that, similar to dialysis populations (29), small solute clearances of a substance like urea may in fact influence appetite and therefore qualify as a reliable marker of uremic toxicity as far as anorexia is concerned (30).…”

Section: Spontaneous Decline Of Nutritional Status With Declining Rensupporting

confidence: 85%

Renal Kt/V_urea and PNA_n: “New” Criteria for the Initiation of Chronic Dialysis

Saran

Agrawal

Nolph

1999

Seminars in Dialysis

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Section: Spontaneous Decline Of Nutritional Status With Declining Rensupporting

confidence: 85%

Renal Kt/V_urea and PNA_n: “New” Criteria for the Initiation of Chronic Dialysis

Saran

Agrawal

Nolph

1999

Seminars in Dialysis

Self Cite

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“…Mehrotra et al reported on the slope of the regression line between Kt/V urea and nPNA in patients with chronic renal failure (2). This slope was not different from that found in a previous study in continuous ambulatory peritoneal dialysis (CAPD) patients from the same institution (3). However, no information was provided on the contribution of renal Kt/V urea to total Kt/V urea in the CAPD population.…”

contrasting

confidence: 55%

“…Moreover, studies have shown that factors other than mathematical coupling influence the relationship between Kt/V urea and nPNA. These factors include dialysis modality, dialyzer membrane, and age (3,18,20,27). Thus, the slope or the intercept of the regression line between Kt/V urea and nPNA can provide information on the mutual relationship between these parameters in various patient groups.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Kt/V_Urea and Npna in Anuric Peritoneal Dialysis Patients: A Comparison with Predialysis Patients

Jansen

Korevaar²,

Dekker

et al. 2001

Perit Dial Int

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Objective It is unknown whether a given level of urea clearance by the native kidneys provides better or similar control of uremia than the same level of urea clearance by continuous peritoneal dialysis (PD). More insight into possible differences between renal and peritoneal urea clearances is warranted. Therefore, we investigated the relationship between Kt/Vurea and protein equivalent of total nitrogen appearance normalized to body weight (nPNA), the relationship between urea clearance and creatinine appearance, and other nutritional parameters in PD patients without residual renal function, and in predialysis end-stage renal disease patients. Patients All patients participated in the Netherlands Cooperative Study on the Adequacy of Dialysis. This is a prospective cohort study of incident dialysis patients, in whom regular assessments of renal function are done. A group of 75 PD patients was identified at the first follow-up assessment in which their urine production was less than 100 mL/day. These patients were considered the anuric group. This group was compared with a control group of 97 predialysis patients studied 0 – 4 weeks before the start of dialysis treatment. Results Linear relationships were present between Kt/Vurea and nPNA, in both the predialysis patients and the anuric PD patients. A significant difference was present between the slopes of the two regression lines (0.40 vs 0.18, p = 0.007). When Kt/Vurea exceeded 1.3/week, a given level of Kt/Vurea was associated with a higher nPNA in predialysis than in anuric PD patients. Similar relationships were found between Kturea and PNA. Kturea was also significantly related to urine or dialysate creatinine appearance. A significant difference existed between the slopes of the regression lines in the two groups of patients ( p < 0.001). A weekly Kturea of 70 L was associated with a urine creatinine appearance of 11.0 mmol/day and a dialysate creatinine appearance of 8.4 mmol/day. Nutritional status measured with creatinine appearance and Subjective Global Assessment was better in the predialysis population, despite much lower values for Kt/Vurea in these patients. Conclusions The relationship between Kt/Vurea and nPNA in anuric PD patients is different from that in a predialysis population. It follows from our results that, when Kt/Vurea is above 1.3/week, a given level of Kt/Vurea is associated with a higher nPNA in predialysis than in anuric PD patients. This challenges the concept of equivalency between renal and peritoneal Kt/Vurea with respect to control of uremic morbidity.

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“…Other studies have faced the problem of an adequate dialysis dose from other points of view. They demonstrated that an increasing dialysis dose has beneficial effects on protein intake (12,13), nutritional status (14-16), and red-cell count (17). It is noteworthy that, in all these studies, the suggested Kt/V is about 2.0, thus confirming the target suggested by the survival analysis (2,6).…”

Section: Patient Survivalmentioning

confidence: 99%

Long-Term Peritoneal Dialysis Outcome in a Single Center

et al. 2000

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A New Approach to Optimizing Urea Clearances in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis

Cited by 14 publications

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Renal Kt/V_urea and PNA_n: “New” Criteria for the Initiation of Chronic Dialysis

Renal Kt/V_urea and PNA_n: “New” Criteria for the Initiation of Chronic Dialysis

The Relationship between Kt/V_Urea and Npna in Anuric Peritoneal Dialysis Patients: A Comparison with Predialysis Patients

Long-Term Peritoneal Dialysis Outcome in a Single Center

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A New Approach to Optimizing Urea Clearances in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis

Cited by 14 publications

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Renal Kt/Vurea and PNAn: “New” Criteria for the Initiation of Chronic Dialysis

Renal Kt/Vurea and PNAn: “New” Criteria for the Initiation of Chronic Dialysis

The Relationship between Kt/VUrea and Npna in Anuric Peritoneal Dialysis Patients: A Comparison with Predialysis Patients

Long-Term Peritoneal Dialysis Outcome in a Single Center

Contact Info

Product

Resources

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Renal Kt/V_urea and PNA_n: “New” Criteria for the Initiation of Chronic Dialysis

Renal Kt/V_urea and PNA_n: “New” Criteria for the Initiation of Chronic Dialysis

The Relationship between Kt/V_Urea and Npna in Anuric Peritoneal Dialysis Patients: A Comparison with Predialysis Patients