Effects of Postdialysis Urea Rebound on the Quantification of Pediatric Hemodialysis

Marsenić, Olivera; Pavličić, Dubravka; Bigović, Gordana; Peco-Antić, Amira; Jovanović, O

doi:10.1159/000045559

Cited by 5 publications

(5 citation statements)

References 16 publications

(36 reference statements)

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“…22,23 However, estimation of equilibrated Kt/V only is not sufficient in pediatric practice, because C eq value is necessary for accurate nutritional assessment (Gu and nPCR) that is an essential component of pediatric HD adequacy measurement. 28 Our results and prior research 12 show that spnPCR significantly overestimates nPCR, with the difference between the means of spnPCR and enPCR of 0.07 gr/kg/d in our study and 0.08 gr/kg/d in a previous report. 12 IBKM-predicted equilibrated urea value provides an accurate assessment of nPCR, verifying that IBKM is a valuable tool for pediatric HD management.…”

Section: Discussionsupporting

confidence: 68%

“…28 Our results and prior research 12 show that spnPCR significantly overestimates nPCR, with the difference between the means of spnPCR and enPCR of 0.07 gr/kg/d in our study and 0.08 gr/kg/d in a previous report. 12 IBKM-predicted equilibrated urea value provides an accurate assessment of nPCR, verifying that IBKM is a valuable tool for pediatric HD management. C eq value also allows direct estimation of true URR.…”

Section: Discussionsupporting

confidence: 68%

“…Results of this work were previously published. 12,15,17 For use in the current study, this dataset was de-identified and therefore exempt from Institutional Review Board (IRB) approval.…”

Section: Subjects and Datamentioning

confidence: 99%

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Application of Individualized Bayesian Urea Kinetic Modeling to Pediatric Hemodialysis

Marsenić

Zhang²,

Zuppa³

et al. 2010

ASAIO Journal

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Incorporating urea rebound using equilibrated urea concentration (Ceq) after hemodialysis (HD) is essential for accurate assessment of HD efficiency. It is impractical to measure Ceq in clinical settings, and there are no recommended methodologies to predict Ceq in children. The objective of this work is to assess the ability of an Individualized Bayesian Urea Kinetic Model (IBKM) for predicting Ceq in children receiving HD. Developed based on adult HD data, the IBKM is a two-pool urea kinetic model that calculates Bayesian estimates of individual Ceq. Blood urea nitrogen (BUN) samples from 30 HD sessions in 13 children (age 12-18 years) were taken at pre-HD, immediately post-HD, and 60 minutes post-HD (Ceq). The IBKM and estimated population parameters from adult data were fitted to the observed data from children to predict individual Ceq using NONMEM VI software in comparison with observed Ceq (9.5 +/- 3.8 mmol/L), the average individual predicted Ceq was 9.4 +/- 3.8 mmol/L, with absolute individual prediction error of 6.2% +/- 4.4%. For a given dialysis goal and desired dialysis duration, the required blood flow rate and dialyzer size are predicted by IBKM and confirmed by the analysis data. This study suggests that the IBKM can be used in a pediatric HD setting and accurately predict Ceq in children using only pre-HD and immediately post-HD BUN.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionsupporting

confidence: 68%

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Application of Individualized Bayesian Urea Kinetic Modeling to Pediatric Hemodialysis

Marsenić

Zhang²,

Zuppa³

et al. 2010

ASAIO Journal

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“…Single pool Kt/V and nPCR were computed by the variable volume single pool urea kinetic model (VVSP) [5], using the personal computer software program ‘Kinetic Information System’ Version 2.8, CompuMod Software. Kt/V and nPCR were not corrected for the effects of urea rebound, which we previously documented [6]. Urea concentrations before, at the end of, and before the following HD were used.…”

Section: Methodsmentioning

confidence: 99%

Effect of Dialysis Dose on Nutritional Status of Children on Chronic Hemodialysis

Marsenić

Peco-Antić²,

Jovanović³

2001

Nephron

Self Cite

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It had been suggested that larger hemodialysis (HD) doses in children could result in better appetite, higher protein intake, better nutritional status and better growth. We investigated how different HD doses affect protein intake and nutritional status of children on chronic HD. Indices of nutritional status used were normalized protein catabolic rate (nPCR) calculated by formal 3-sample urea kinetic modeling and serum albumin level. Data of 38 HD sessions in 15 stable patients (6 males, 9 females) aged 14.5 ± 3.28 years (mean ± SD) were analyzed. HD sessions were divided into three groups based on delivered Kt/V: group 1 (n = 5), inadequate (Kt/V < 1.3, mean 1.05 ± 0.14); group 2 (n = 12), adequate (Kt/V = 1.3–1.6, mean 1.50 ± 0.07) and group 3 (n = 21), high (Kt/V >1.6, mean 1.94 ± 0.22). Mean nPCR and Kt/V per patient during the studied week were estimated for 11 patients in whom 3 HD sessions were available within the 38 sessions analyzed. Serum albumin level was adequate in all patients (43.77 ± 2.28 g/l). Mean overall Kt/V and nPCR were 1.68 ± 0.36 and 1.26 ± 0.23, respectively, r = 0.430. Average nPCR differed between groups depending on Kt/V. It was lowest in group 1 (1.01 ± 0.12 g/kg/day) where the highest correlation between nPCR and Kt/V was found (r = 0.648). nPCR was higher and similar in groups 2 (1.27 ± 0.23 g/kg/day) and 3 (1.31 ± 0.22 g/kg/day), with low correlation coefficients between nPCR and Kt/V in both groups (r = 0.275 and r = 0.197, respectively). A weak positive correlation (r = 0.249) between nPCR and Kt/V was found when average weekly values per patient (n = 11) were analyzed. Results of groups 1 and 2 confirm, what is already well established in adults, that adequate dialysis needs to be achieved in order to insure good protein intake. However, our data clearly show that nPCR did not increase with a further increase in delivered HD dose, i.e. Kt/V >1.6. Our results show that the nutritional status of children on chronic HD does not seem to benefit from very high HD doses (Kt/V >1.6).

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“…Calculation of Kt/V by double-pool kinetics (eqKt/V) is based on a post-dialysis BUN level actually drawn or estimated after the completion of urea rebound. Numerous studies in both children and adults have demonstrated that urea rebound ranges from 7.6% to 24% and accounts for a 12.3% to 16.8% difference between spKt/V and eqKt/V values (10)(11)(12)(20)(21)(22).…”

Section: Hemodialysis Adequacymentioning

confidence: 99%

Advances in renal replacement therapy as a bridge to renal transplantation

Goldstein

2007

Pediatric Transplantation

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While renal transplantation remains the most prevalent treatment for children with end-stage renal disease, the majority of children incident to ESRD receive dialytic therapy prior to receiving a renal allograft and 25% of children are still receiving dialytic therapy 36 months after achieving ESRD. The current review discusses the most recent advancements in both hemodialysis and PD therapies to provide optimal care for children as a bridge until renal transplantation. Areas covered include dialysis dose assessment, target dry weight assessment, vascular access and advancements in PD technology.

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Effects of Postdialysis Urea Rebound on the Quantification of Pediatric Hemodialysis

Cited by 5 publications

References 16 publications

Application of Individualized Bayesian Urea Kinetic Modeling to Pediatric Hemodialysis

Application of Individualized Bayesian Urea Kinetic Modeling to Pediatric Hemodialysis

Effect of Dialysis Dose on Nutritional Status of Children on Chronic Hemodialysis

Advances in renal replacement therapy as a bridge to renal transplantation

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