Adequacy of hemodialysis

Suri, Rita S.; Blake, Peter G.

doi:10.1007/978-1-4020-2275-3_22

Cited by 4 publications

(5 citation statements)

References 165 publications

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“…It was carried out during the second hemodialysis session of the week. The Std Kt/V also calculated from UKM based on Gotch's initial paper (5). Reduction ratios for CysC (CCRR), urea (URR), and creatinine (CRR) were calculated by taking the difference between pre-and postdialysis levels, and divided by predialysis levels.…”

Section: Methodsmentioning

confidence: 99%

“…Kt/V values may be given for single-pool (Sp Kt/V) or doublepool (equilibrated or eKt/V) volumes of distribution; they depend upon the urea reduction ratio (URR) over a single hemodialysis treatment (4). To assess dialysis efficiency over a period of 1 week, Gotch derived a new dialysis assessment index named the weekly "standardized" Kt/V (Std Kt/V) (5,6). Std Kt/V allows comparison of different dialysis modalities (e.g., peritoneal versus hemodialysis) and weekly treatment frequencies.…”

Section: Introductionmentioning

confidence: 99%

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Cystatin C Reduction Ratio Depends on Normalized Blood Liters Processed and Fluid Removal during Hemodialysis

Huang

Filler

Yasin

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives A negative correlation between the weekly standard Kt/V (urea) and serum cystatin C level (CysC) in functionally anephric dialysis patients has been previously demonstrated. Our objective was to measure the per dialysis CysC reduction ratio (CCRR) and to compare it with other indices of dialytic functions.Design, setting, participants, & measurements In a pilot cross-sectional study of 15 functionally anephric patients on conventional high-flux high-efficiency hemodialysis three times per week, CysC levels were drawn pre-, mid-, and postdialysis over 1 week. CCRR was compared with single-pool Kt/V (Sp Kt/V) using urea kinetic modeling, urea reduction ratio (URR), creatinine reduction ratio (CRR), normalized liters processed (LP/kg), and ultrafiltration volume (UF). Normally distributed data (Shapiro-Wilks test) were described as mean Ϯ SD, otherwise as median and interquartile range. ResultsThe mean pre-and post-CysC levels were 6.0 Ϯ 1.0 and 4.7 Ϯ 1.1 mg/L. The Sp Kt/V and Std Kt/V were 1.5 Ϯ 0.2 and 2.6. The URR, CRR, and CCRR were 70.2% Ϯ 9.0%, 64.5% Ϯ 8.2%, and 26.1% Ϯ 11.8%, respectively. There was no correlation between the CCRR, and the Sp Kt/V, URR, and CRR, whereas CCRR correlated with LP/kg and UF. Multiple regression analysis with these two parameters provided a model that explained 81% of the variance. ConclusionsOur data suggest that normalized liters processed and ultrafiltration volume explain most of the variance of CCRR. Therefore, CCRR may be an excellent method to monitor dialysis efficiency of low molecular weight proteins.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cystatin C Reduction Ratio Depends on Normalized Blood Liters Processed and Fluid Removal during Hemodialysis

Huang

Filler

Yasin

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Adjusted oedema-free body weight (aBWef), based on the dry body weight and the standard body weight, has been recommended for nPNA normalization [ 2 ]. However, aBWef includes NHANES II (National Health and Nutrition Examination Survey) tables specific to US and may not be suitable for other countries [ 15 ]. With extreme obese or oedematous patients, care must be taken to estimate V and PNA [ 22 ] that could be valid for some studied patients but not in general.…”

Section: Discussionmentioning

confidence: 99%

“…A way to normalize nPNA is to use the "kinetic body weight" 0.58, V where V is calculated using some iterative algorithm or anthropometric formula [ 15 ]. The most common anthropometric formula is called the Watson formula [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…The most common anthropometric formula is called the Watson formula [ 1 ]. The measured dry body weight or oedema free body weight (efBW) [ 2 ], obtained post-dialysis in HD patients, has been used [ 6 ], which may lead to nPNA underestimation [ 15,16 ]. However, efBW may be used effectively when the value is close to the standardized body weight [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Nutrition estimation of dialysis patients by on-line monitoring and kinetic modelling

Fridolin

Lauri²,

Jerotskaja³

et al. 2008

Estonian J. Eng.

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The aim of this study was to estimate a nutritional parameter, normalized protein nitrogen appearance (nPNA), for haemodialysis (HD) patients by on-line monitoring with the optical dialysis adequacy monitor (DIAMON) prototype, by the modified direct dialysis quantification (mDDQ), and by the volume-variable single-pool urea kinetic modelling (VVSP UKM). Ten HD patients were monitored on-line by the DIAMON prototype during three consecutive haemodialysis sessions during one week. Blood samples were taken and the total dialysate collection (TDC) was performed during all dialyses. The nPNA values were estimated by DIAMON, mDDQ and VVSP UKM; nPNA was normalized by V/0.58 and by the measured dry body weight, efBW. Individual nPNA for each patient during a seven-day period was estimated using UV-absorbance measured on-line by the DIAMON prototype. The nPNA values (mean ± SD) in g/kg/day for the total material were: 1) 0.74 ± 0.12 from DIAMON (N = 28), 0.90 ± 0.26 from mDDQ (N = 29) and 0.90 ± 0.23 from VVSP UKM (N = 30) normalized by V/0.58, and 2) 0.68 ± 0.10 from DIAMON (N = 28), 0.72 ± 0.19 from mDDQ (N = 29) and 0.80 ± 0.18 from VVSP UKM (N = 30) normalized by efBW. The optical device for monitoring the dialysis adequacy enables individual nPNA estimation for each patient using continuous, on-line UV-absorbance measurements. The results are comparable to the nPNA values obtained by the kinetic modelling. Still a question remains concerning the normalization of PNA.

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The effect of increased frequency of hemodialysis on serum cystatin C and β2‐microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial

Huang

Kaysen

Levin

et al. 2019

Hemodialysis International

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Introduction: Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta‐2 microglobulin (β2‐M) are understudied. We hypothesized that lowering of predialysis CysC and β2‐M serum concentrations would be affected by switching to more frequent hemodialysis. Methods: Predialysis CysC and β2‐M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12‐months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2‐M concentrations and outcomes. Findings: Forty‐nine percent and 52% of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2‐M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (−3.8 ± 12.62 μg/mL, P = 0.004; −5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12‐months predialysis β2‐M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12‐months and in changes in left ventricular mass, physical‐health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. Discussion: β2‐M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long‐lived proteins of the size of β‐2M is one potential long‐term benefit of more intensive dialysis that may be explored.

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Adequacy of hemodialysis

Cited by 4 publications

References 165 publications

Cystatin C Reduction Ratio Depends on Normalized Blood Liters Processed and Fluid Removal during Hemodialysis

Cystatin C Reduction Ratio Depends on Normalized Blood Liters Processed and Fluid Removal during Hemodialysis

Nutrition estimation of dialysis patients by on-line monitoring and kinetic modelling

The effect of increased frequency of hemodialysis on serum cystatin C and β2‐microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial

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