Influence of the Ionic Dialysance Monitor on Kt Measurement in Hemodialysis

Maduell, Francisco; Vera, Manel; Arias, Marta; Serra, Núria; Blasco, Miguel; Bergadá, E; Fontseré, Néstor; Cases, Aleix; Campistol, Josep M.

doi:10.1053/j.ajkd.2008.03.014

Cited by 26 publications

(14 citation statements)

References 21 publications

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“…In addition, after taking into account or eliminating vascular access and cardiopulmonary recirculation, no difference between the two variables was present (14 -16). Recently, it was investigated whether ionic dialysance values and Kt measurements are affected by different ionic dialysance monitors (17). Indeed, some differences between different monitors were found, and although the authors found that Kt is a valid method for judging dialysis dosage in real time by using ionic dialysance measurements, they suggested that adjustments to correct intermethod differences may be necessary to ensure generalizability among ionic dialysance monitors in different dialysis machines.…”

Section: Kt/v Urea and Online Quantification Of Dialysis Dosagementioning

confidence: 99%

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

Lameire¹,

Biesen²,

Vanholder³

2009

Clinical Journal of the American Society of Nephrology

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During the past two decades, impressive technological innovations have been introduced in the field of hemodialysis. This review analyzes whether these have been translated into better patient survival. The potential impacts of an increase in dialysis dosage, the preference of high-flux versus low-flux membranes, the choice between convection and diffusion as dialysis strategy, the chemical composition and biologic purity of dialysate, the effect of sodium, potassium, volume profiling, and the intradialytic volume monitoring aiming at improving hemodynamic stability are explored. Studies in which the dialysis dosage was increased were not associated with increased patient survival, whereas the superiority of high-flux over low-flux membranes is not convincingly demonstrated. Although strict evidence is lacking, observational data suggest an advantage of convective over pure diffusive strategies. Longer duration of the dialysis sessions and/or higher frequency of dialysis is probably beneficial, but the results of powerful randomized, controlled trials should be awaited. Sodium profiling has more disadvantages than advantages, whereas potassium profiling mainly in arrhythmia-prone patients with ventricular hypertrophy should be considered. Intradialytic blood volume monitoring has reduced intradialytic hypotension episodes, but hard evidence for improving patient survival is lacking. Overall, the major technological advances in dialysis have not yet been translated into longer patient survival. Optimal predialysis care in preventing the cardiovascular damage that accumulates before the start of dialysis and timely creation of an arteriovenous fistula as vascular access is a more effective and more economic strategy in the long-term outcome of the dialysis patient.

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Section: Kt/v Urea and Online Quantification Of Dialysis Dosagementioning

confidence: 99%

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

Lameire¹,

Biesen²,

Vanholder³

2009

Clinical Journal of the American Society of Nephrology

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“…If the corresponding Kt/V urea is required, it can be obtained automatically by dividing Kt urea by some estimate of urea distribution volume retrieved from the patient's electronic prescription record. While the Fresenius and Gambro systems yield slightly different values for Kt urea , methods to convert values between the two systems have been developed [6] . Ionic clearance technology obviates the need for blood samples and allows the delivered dose of dialysis to be determined for every treatment compared to the once per month determination typical for blood-based methods.…”

Section: Achieving a More Effective Dialysis Treatmentmentioning

confidence: 99%

Improvements in Technology: A Path to Safer and More Effective Hemodialysis

Ward¹,

Ronco²

2009

Blood Purif

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Effective dialysis therapy is now understood to encompass both small and large solute removal, using approaches that minimize intradialytic symptoms and maximize patient safety. Achieving the goal of providing effective dialysis for an expanding population of patients with increasingly complex medical problems at a time of limited resources will require technological innovation. To address this need, the latest generation of ergonomically designed dialysis machines incorporates as standard features the technology required to perform on-line convective therapies to maximize large solute removal, on-line measurement of ionic clearance to monitor small solute removal and real-time data processing to guide the delivery of therapy. In addition, these machines feature feedback control systems that may help reduce the unpleasant side effects associated with fluid removal during hemodialysis. These technological innovations offer therapeutic versatility while, at the same time, reducing the burden on patient care personnel, and are likely to make an important contribution to delivering safer and more effective dialysis therapy.

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“…The incorporation of online dialysance (Kt) in monitors in the last few years has allowed the dialysis dose to be controlled in real time and in each session [3]. In our previous study [4], we concluded that unexplained and persistent Kt reductions in patients with stable chronic kidney disease under hemodialysis could represent a practical and additional indirect method for the early detection of significant vascular lesions.…”

Section: Introductionmentioning

confidence: 99%

Observational Study of Surveillance Based on the Combination of Online Dialysance and Thermodilution Methods in Hemodialysis Patients with Arteriovenous Fistulas

Fontseré

Mestres²,

Burrel

et al. 2014

Blood Purif

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Background/Aims: Online dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs. This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group. Methods: We studied 148 hemodialysis patients with arteriovenous fistulas (control group, n = 74) for 2 years. During the study period, the indications for vascular treatments were the Kt reduction ≥20% with respect to baseline values or Qa <500 ml/min (or a decrease in flow >20%). Results: During the study period, we detected 16 cases of vascular dysfunction. The Kt value after vascular treatment was 71.1 liters (59 liters; p = 0.001) and BTM-Qa was 1,218.6 ml/min (519.7 ml/min; p = 0.001). Compared with the control group, the thrombosis rate was 0.027 versus 0.148 episodes/patient-year (p = 0.009) and the total access-related cost was EUR 22,293 versus 47,467 (p = 0.033). Conclusions: This study suggests that a combined monitoring program based on Kt and BTM-Qa represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments.

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Influence of the Ionic Dialysance Monitor on Kt Measurement in Hemodialysis

Cited by 26 publications

References 21 publications

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

Improvements in Technology: A Path to Safer and More Effective Hemodialysis

Observational Study of Surveillance Based on the Combination of Online Dialysance and Thermodilution Methods in Hemodialysis Patients with Arteriovenous Fistulas

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