Dialysis dose (Kt/V) and clearance variation sensitivity using measurement of ultraviolet-absorbance (on-line), blood urea, dialysate urea and ionic dialysance

Uhlin, Fredrik; Fridolin, Ivo; Magnusson, Martin; Lindberg, Lars‐Göran

doi:10.1093/ndt/gfl147

Cited by 54 publications

(61 citation statements)

References 17 publications

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“…An innovative optical method determines the concentration of cleared waste solutes by measuring UV absorbance of the dialysate [3]. The close correlation between dialysate UV absorbance and the removal of urea allows continuous calculation of Kt/V values [4]. Several studies have validated this method, showing a close correlation of approximated Kt/V values to the laboratory-determined Kt/V value based on urea analyses in blood samples [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…The close correlation between dialysate UV absorbance and the removal of urea allows continuous calculation of Kt/V values [4]. Several studies have validated this method, showing a close correlation of approximated Kt/V values to the laboratory-determined Kt/V value based on urea analyses in blood samples [4,5]. A potential advantage of the optical online system is its continuous monitoring of Kt/V, which may help to immediately address intra-dialytic variations in dialysis adequacy as caused by needle displacement, recirculation, hypotension and clotting [6].…”

Section: Introductionmentioning

confidence: 99%

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Online Kt/V Monitoring in Haemodialysis by UV Absorbance: Variations during Intra-Dialytic Meals

et al. 2014

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Background/Aims: The aim of this study was to analyse if intra-dialytic food intake may lead to changes in online Kt/V. Methods: Forty patients were analysed using haemodialysis machines with integrated online Kt/V monitoring based on UV absorbance or ionic dialysance. Kt/V was monitored before, during and after food intake. Samples of dialysate were analysed for urea, uric acid, creatinine and glucose levels. Results: Food intake was associated with a significant decrease in relative Kt/V when determined by UV absorbance. The drop in Kt/V was independent of changes in blood pressure or body posture. No significant changes in online Kt/V were found using the ionic dialysance method. Dialysate samples showed a continuous clearance of urea, uric acid and creatinine during meals but a rapid increase in glucose. Conclusion: Our data suggest that the short meal-associated decrease in online Kt/V as measured by UV absorbance does not represent a true decline in Kt/V but might reflect an intermittent increase in UV-absorbing dialysed solutes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Online Kt/V Monitoring in Haemodialysis by UV Absorbance: Variations during Intra-Dialytic Meals

et al. 2014

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“…Earlier studies have shown that UV absorptions at 280, 285 and 297 nm have a close correlation with urea-based dialysis dose estimation [11,13,14]. This made it possible to develop a clinically validated online dialysis adequacy monitoring system [15].…”

Section: Introductionmentioning

confidence: 99%

Do Only Small Uremic Toxins, Chromophores, Contribute to the Online Dialysis Dose Monitoring by UV Absorbance?

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Uhlin

et al. 2012

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The aim of this work was to evaluate the contributions of the main chromophores to the total UV absorbance of the spent dialysate and to assess removal dynamics of these solutes during optical on-line dialysis dose monitoring. High performance chromatography was used to separate and quantify UV-absorbing solutes in the spent dialysate sampled at the start and at the end of dialysis sessions. Chromatograms were monitored at 210, 254 and 280 nm routinely and full absorption spectra were registered between 200 and 400 nm. Nearly 95% of UV absorbance originates from solutes with high removal ratio, such as uric acid. The contributions of different solute groups vary at different wavelengths and there are dynamical changes in contributions during the single dialysis session. However, large standard deviation of the average contribution values within a series of sessions indicates remarkable differences between individual treatments. A noteworthy contribution of Paracetamol and its metabolites to the total UV absorbance was determined at all three wavelengths. Contribution of slowly dialyzed uremic solutes, such as indoxyl sulfate, was negligible.

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“…drain tube) of the dialysis machine, as in earlier studies [15,16,17], with all spent dialysate and ultrafiltrate passing through a rectangular optical flow cuvette (JASCO) with a path length of 10 mm. To find out if it would be possible to create a specific single-wavelength model for phosphate similarly to an earlier study [17], a single wavelength of 297 nm was selected using a bandwidth of 2 nm. The sampling frequency was set to 30 samples/min (= 0.5 Hz).…”

Section: Methodsmentioning

confidence: 99%

Utilization of UV Absorbance for Estimation of Phosphate Elimination during Hemodiafiltration

et al. 2012

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Background: Phosphate is an important factor in explaining the high progress of vascular calcification among dialysis patients. Today, phosphate concentration is measured in plasma on a regular basis. The aim of this study was to find out if it is possible to estimate total removed phosphate (TRp) in spent dialysate utilizing UV absorbance during hemodiafiltration. Methods: Eleven patients were monitored online with UV absorbance at 297 nm, three times during one week each (n = 33). Dialysate samples were taken at different times during treatment and from a collection tank to chemically determine phosphate concentrations. Two mathematical models (UVIND and UVGROUP) were tested to estimate TRp with supervision by UV absorbance and compared with TRp measured in the tank (reference). Results: High correlation between UV absorbance and phosphate concentration for each single patient and lower for the whole group together was found. TRp was (mean ± SD) 30.7 ± 7.3 mmol for the reference and 30.8 ± 8.2 and 29.1 ± 5.2 mmol for UVIND and UVGROUP, respectively (p > 0.05). Conclusion: This study demonstrates a novel possibility to estimate TRp based on linear relationship between online monitoring of UV absorbance and concentration of phosphate in spent dialysate.

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Dialysis dose (Kt/V) and clearance variation sensitivity using measurement of ultraviolet-absorbance (on-line), blood urea, dialysate urea and ionic dialysance

Cited by 54 publications

References 17 publications

Online Kt/V Monitoring in Haemodialysis by UV Absorbance: Variations during Intra-Dialytic Meals

Online Kt/V Monitoring in Haemodialysis by UV Absorbance: Variations during Intra-Dialytic Meals

Do Only Small Uremic Toxins, Chromophores, Contribute to the Online Dialysis Dose Monitoring by UV Absorbance?

Utilization of UV Absorbance for Estimation of Phosphate Elimination during Hemodiafiltration

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