Comparison of volume of blood processed on haemodialysis adequacy measurement sessions vs regular non-adequacy sessions

Brimble, K. Scott; Onge, Joye St.; Treleaven, Darin; Carlisle, Euan

doi:10.1093/ndt/17.8.1470

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…[19] Brimble et al used the volume of blood processed (VBP) as a surrogate marker of delivered dialysis, and compared VBP on days adequacy was measured to days it was not. [20] They found that more than 20% of patients had a significant reduction in VBP on the days adequacy was not assessed. [20] K ID t/V ID is an alternative method that clinicians may use to follow adequacy during each dialysis session; additionally, K ID t/V ID may enable clinicians to follow total weekly or monthly Kt/V.…”

Section: Discussionmentioning

confidence: 99%

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Estimating Dialysis Adequacy Using Ionic Dialysance

Carl

Feldman

2008

Renal Failure

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The aim of this study was to determine the efficacy and feasibility of estimating dialysis adequacy using ionic dialysance (ID). We retrospectively reviewed the medical records of patients receiving thrice weekly dialysis for an eight-month period at a single-center Veterans Affairs hospital. Dialysis adequacy was determined monthly using pre- and post-treatment BUN measurements to calculate the single pool Kt/V (spKt/V) with the formula set forth by Daugirdas. On the same treatment day, K(ID)t was determined by multiplying the average ID times the time (t) of the treatment. A surrogate volume, V(ID), was estimated by dividing K(ID)t by spKt/V using data from the first six months. During the subsequent two months, we compared dialysis adequacy estimated by urea-based spKt/V to ionic dialysance based K(ID)t/V(ID) utilizing V(ID). In the first month, K(ID)t/V(ID) estimations and the simultaneous spKt/V determinations averaged 1.55 +/- 0.36 and 1.59 +/- 0.42, respectively. In the second month, K(ID)t/V(ID) and spKt/V averaged 1.52 +/- 0.33 and 1.54 +/- 0.35, respectively. K(ID)t/V(ID) correlated well with spKt/V, as the slope was 0.85 (r = 0.95, p < 0.001). There was considerable intra-patient variability of K(ID), time, and K(ID)t/V(ID) with coefficient of variations (CV) of 8.4 +/- 4.3, 9.0 +/- 5.3, and 15.8 +/- 9.2, respectively. However, the CV for K(ID)t/V(ID) was similar to the CV for spKt/V (15.3 +/- 7.4). These results suggest that it is possible to estimate dialysis adequacy during every treatment using K(ID)t/V(ID). Furthermore, there is considerable variability in the delivered dialysis adequacy, suggesting that many sessions result in sub-optimal dialysis.

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Section: Discussionmentioning

confidence: 99%

“…[20] They found that more than 20% of patients had a significant reduction in VBP on the days adequacy was not assessed. [20] K ID t/V ID is an alternative method that clinicians may use to follow adequacy during each dialysis session; additionally, K ID t/V ID may enable clinicians to follow total weekly or monthly Kt/V.…”

Section: Discussionmentioning

confidence: 99%

Estimating Dialysis Adequacy Using Ionic Dialysance

Carl

Feldman

2008

Renal Failure

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“…Several contributors to the discussion of on-line clearance monitoring were concerned that a single monthly check on dialysis dose could be misleading. Knowing that the blood tests are due could mean staff take extra care to have the right blood flow and the full treatment time [14].…”

Section: Summary Of the Edtna|erca Journal Club Discussion Summer 2006mentioning

confidence: 99%

ON LINE UV‐ABSORBANCE MEASUREMENTS: Summary of the EDTNA|ERCA Journal Club discussion Summer 2006

Lindley

Tattersall²,

Vos³

et al. 2007

Journal of Renal Care

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The discussion was initiated by a paper comparing the measurement of dialysis dose (Kt/V) and solute clearance using on-line ultra-violet absorbance, blood and dialysate urea and ionic dialysance by Uhlin et al (NDT 2006). Participants from 14 countries discussed the theory behind the UV absorbance technique and the potential for its use in routine practice, the correlation between Kt/V measured using different methods, the use of ionic dialysance and the optimisation of dose monitoring. The 'take-home' messages from the discussion were that UV-absorbance could help ensure the delivery of dialysis dose as it provides real time feedback on the effect interventions such as repositioning of needles. The technology is relatively inexpensive and requires no consumables but changes in the dialysis machine settings could lead to misleading measurements if not communicated to the UV monitor. Session-to-session variation in dialysis dose can be measured using on-line clearance monitoring. If it is already on the machine and costs nothing, why not use it? Alternatively, regular access recirculation checks and a record of the total blood volume processed at each session allow problems with delivered dialysis dose to be picked up between routine blood tests.

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“…The clustering of URR values to facilities are reported by some as reflective of facility‐specific URR sampling practices . Evidence suggest that facility URRs largely overestimate clearances provided; when blood volume processed is measured, it is higher on URR draw days than other days, and depends more on nursing factors than patient factors . Keeping blood flow rates above 350 mL/min, in one study, was effective in improving outcomes, especially in women and older individuals .…”

Section: Stakeholder‐level Risks To Hospitalizations In Patient On Hementioning

confidence: 99%

“…[130][131][132] Evidence suggest that facility URRs largely overestimate clearances provided; when blood volume processed is measured, it is higher on URR draw days than other days, and depends more on nursing factors than patient factors. [132][133][134] Keeping blood flow rates above 350 mL/min, in one study, was effective in improving outcomes, especially in women and older individuals. 62 Neither vascular access surveillance nor recirculation measurements (important to maintaining good clearances) are routinely carried out or are inaccurately performed.…”

Section: Psychosocialmentioning

confidence: 99%

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Golestaneh

2018

Seminars in Dialysis

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Hospitalizations drive up to 35% of the astronomical costs of care for patients on hemodialysis and are associated with poor outcomes. We describe outpatient care-sensitive categories of hospitalization risks in an effort to engage stakeholders and patients, as stakeholders, in mitigating hospitalizations. These categories include: (1) fluid (interdialytic weight gain (IDWG) and chronic volume status), (2) infection (vascular access and malnutrition/inflammation resilience), and c) psychosocial (poor social support, poor self-efficacy, and mood disorders) risks. Barriers to improving hospitalization outcomes, especially as they relate to above risk categories, exist at multiple stakeholder levels and include: (1) dialysis facilities (strict shift changes, personnel challenges), (2) nephrologists (static dialysis prescriptions and protocols based on dialysis facility metrics), and (3) patients (lack of engagement and self-efficacy). System-level elements, such as payment models, help to propagate these barriers. In this article, we seek to shift the care paradigm discussion to patient trajectories and long-term outcomes, and to active engagement of patients as self-managers, through which we hope to impact on high inpatient resource utilization. We will also focus attention on the complex interplay of practices that have become acceptable care structures, but that may be deleterious to outcomes. Only after thorough consideration of these topics can we hope to impact on this important problem.

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Comparison of volume of blood processed on haemodialysis adequacy measurement sessions vs regular non-adequacy sessions

Cited by 12 publications

References 12 publications

Estimating Dialysis Adequacy Using Ionic Dialysance

Estimating Dialysis Adequacy Using Ionic Dialysance

ON LINE UV‐ABSORBANCE MEASUREMENTS: Summary of the EDTNA|ERCA Journal Club discussion Summer 2006

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

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