Effect of treatment frequency on haemodialysis dose: comparison of EKR and stdKt/V

Vartia, Aarne

doi:10.1093/ndt/gfp177

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…The difference in urea concentration was reflected reciprocally by DAI ( table 2 ). Similar observations were obtained when EKR and stdKT/V were compared by other computer simulations [52,53] . The peak average reference method seems to be more sensitive than the time average reference method to the change of frequency and time of dialysis while KT/V is similar and therefore the peak average-based DAI may better correspond to the improved clinical outcomes with long and/ or frequent dialysis.…”

Section: Time and Frequency Of Dialysissupporting

confidence: 84%

Can the Diverse Family of Dialysis Adequacy Indices Be Understood as One Integrated System?

2010

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Background: Dialysis adequacy indices are based on the amount of removed solute and systemized into two groups: (1) fractional solute removal (FSR, non-dimensional), and (2) equivalent continuous clearance (ECC, ml/min), which are expressed using appropriate reference method for solute concentration or mass such as: peak, peak average, time average, and treatment time average values. Methods: A review and critical analysis of the recent studies was performed. Results: The indices are mathematically interrelated and depend on kinetic parameters of the treatment, as device clearance, treatment time, solute distribution volume, dialysis frequency. In particular, KT/V and KT can be directly translated to FSR and ECC using the treatment time average reference method. Conclusion: The diverse family of dialysis adequacy indices can be understood as one integrated system and be useful when assessing both standard treatment modalities and newer schedules and modalities (frequent dialysis, hybrid dialysis, dialysis in acute renal failure) of renal replacement therapies.

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Section: Time and Frequency Of Dialysissupporting

confidence: 84%

Can the Diverse Family of Dialysis Adequacy Indices Be Understood as One Integrated System?

2010

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“…Equivalent renal urea clearance (EKR, Casino and Lopez) [9] and stdK (Gotch) [8,10] take the treatment frequency and residual renal function (RRF) into account and were intended to be used in comparing dialysis doses in different schedules and to continuous dialysis and renal function [11,12]. …”

Section: Methodsmentioning

confidence: 99%

“…stdEKR is less sensitive to treatment frequency [11] and RRF [12] but more sensitive to a poorly spaced schedule than stdK/V [13]. …”

Section: Methodsmentioning

confidence: 99%

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Adjusting Hemodialysis Dose for Protein Catabolic Rate

Vartia

2014

Blood Purif

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Background: Patients dialyzed with equal eKt/V may have huge variations in their urea concentrations. Methods: Urea generation rate, distribution volume and renal clearance were determined in 205 hemodialysis sessions of 33 patients with double pool urea kinetic modeling using dialyzer clearance from online monitoring. From these data, optimized prescriptions were computed. Results: In simulated dialysis sessions, the HEMO standard-dose equivalent clearance was not sufficient to keep time-averaged concentration (TAC) and average predialysis concentration (PAC) of urea below the defined upper limits (20 and 30 mmol/l), if normalized protein catabolic rate (nPCR) was greater than 1.3 g/kg/day. Protein catabolic rate was taken into account in the optimized prescription by cutting high urea concentrations. Conclusions: If patients having high urea concentrations with conventional clearance will benefit from higher dialysis dose - an unconfirmed hypothesis - this approach helps in identifying those who need more than three sessions per week.

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“…Equivalent renal urea clearance (EKR, Casino and Lopez) [10] and standard clearance (stdK, Gotch) [11,12] take treatment frequency and residual renal function (RRF) into account and they were intended for use in comparing dialysis doses in different schedules and for continuous dialysis and renal function [13,14].…”

Section: Introductionmentioning

confidence: 99%

Association of Continuous-Equivalent Urea Clearances with Death Risk in Intermittent Hemodialysis

Vartia

Huhtala

Mustonen

2016

Advances in Nephrology

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Background. Several reports describe favorable results from frequent hemodialysis, but due to the lack of unequivocal dose measures it is not clear whether the benefits are due to more efficient toxin removal or other factors. Methods. The associations with death risk of six continuous-equivalent urea clearance measures were compared in 57 conventional in-center hemodialysis treatment periods of 51 patients, together 114 patient years. The double pool dose measures were calculated with the Solute-Solver program and separately scaled to urea distribution volume or normalized with body surface area. Results. Mortality associated significantly with equivalent renal urea clearance (EKR) scaled to urea distribution volume ( ) ( = 0.033) and with EKR normalized with body surface area (BSA) ( = 0.044) but not with -scaled ( = 0.059) nor BSA-normalized ( = 0.183) standard clearance (stdK). Women had significantly higher normalized protein catabolic rate (nPCR), EKR/ , and stdK/ than men but slightly lower BSA-normalized dose measures and lower mortality. Protein catabolic rate and dialysis dose correlated positively with each other and with survival. Conclusions. The prognostically most valid continuous-equivalent clearance in the present material was EKR/ , calculated from double pool urea generation rate, distribution volume, and time-averaged concentration.

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Effect of treatment frequency on haemodialysis dose: comparison of EKR and stdKt/V

Cited by 10 publications

References 21 publications

Can the Diverse Family of Dialysis Adequacy Indices Be Understood as One Integrated System?

Can the Diverse Family of Dialysis Adequacy Indices Be Understood as One Integrated System?

Adjusting Hemodialysis Dose for Protein Catabolic Rate

Association of Continuous-Equivalent Urea Clearances with Death Risk in Intermittent Hemodialysis

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