Online measurement of hemodialysis adequacy using effective ionic dialysance of sodium—a review of its principles, applications, benefits, and risks

Aslam, Shakil; Saggi, Subodh J.; Salifu, Moro O.; Kossmann, Robert J.

doi:10.1111/hdi.12623

Cited by 20 publications

(29 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients in some areas refuse regular blood tests unless their life is threatened, and the HD machines in these areas often lack online clearance monitoring (OCM). 13 , 14 Therefore, a large number of patients are in danger due to a lack of effective monitoring, which is associated with increased complications and a poor quality of life. We reported the preliminary results of the concordance between ASM- and CLM-derived parameters.…”

Section: Discussionmentioning

confidence: 99%

A novel method to rapidly calculate the urea clearance index and urea reduction rate based on parameters obtained during hemodialysis

Yang

Chen²,

Wang³

et al. 2021

Chronic Diseases and Translational Medicine

View full text Add to dashboard Cite

Background The efficacy of hemodialysis (HD) is closely associated with patient survival time and quality of life. The classical method (CLM) to calculate the urea clearance index (Kt/V) and urea reduction rate (URR) requires multiple blood tests. A novel method that may be used as a noninvasive alternative to CLM is required. Methods Based on the urea kinetic model, a new method, named the “assessment method” (ASM), was established to calculate blood urea nitrogen after HD, based on parameters obtained during HD. The consistency of the Kt/V and URR values between the ASM and CLM was evaluated in 41 patients from the China–Japan Friendship Hospital between September 2017 and December 2018. Results Forty-one patients (24 males and 17 females; mean age, 55.7 ± 14.2 years) undergoing regular HD in our hospital were randomly selected for this study. The blood flow rate was 244.5 ± 19.6 mL/min and the dialysate flow rate was 500 mL/min. We obtained Kt/V (CLM = 1.40 ± 0.06, ASM = 1.37 ± 0.07) and URR (CLM = 68.6 ± 6.4%, ASM = 67.7 ± 7.2%) values. Paired t -test indicated no significant differences between the ASM- and CLM-derived values. The intraclass correlation coefficients were 0.907 and 0.916 for Kt/V and URR, respectively. Similarly, Bland–Altman plots suggested good concordance between the 2 methods. Conclusions The Kt/V and URR values calculated using the ASM and CLM were in significant agreement, and both can be used to effectively assess the adequacy of HD in patients undergoing maintenance HD. The ASM is an effective, rapid, inexpensive, and noninvasive alternative to the CLM for obtaining Kt/V and URR values. The ASM has good potential for clinical application, particularly for patients in areas of low socioeconomic status.

show abstract

Section: Discussionmentioning

confidence: 99%

A novel method to rapidly calculate the urea clearance index and urea reduction rate based on parameters obtained during hemodialysis

Yang

Chen²,

Wang³

et al. 2021

Chronic Diseases and Translational Medicine

View full text Add to dashboard Cite

show abstract

“…28 The studies that had poor correlation, suggested that there may have been an erroneous V calculation. 29,30 In a paper evaluating various studies, Aslam et al 31 concluded that the various online methods available for dialysis adequacy provide a reliable and safe technique while providing excellent correlation with Kt/V.…”

Section: Forty One Hemodialysis Patients Frommentioning

confidence: 99%

Assessment of hemodialysis adequacy: Correlation between online clearance monitoring and single pool Kt/V.

Mansur¹,

Saleem

Mahmood

et al. 2020

TPMJ

View full text Add to dashboard Cite

Objectives: The aim of this study is to correlate the dose of dialysis delivered by both methods in the dialysis population in our developing country. Study Design: Cross Sectional study. Setting: Dialysis Centre at Doctor’s Hospital and Medical Center Lahore. Period: February 1, 2018 to April 30, 2018. Material & Methods: Using Fresenius 4008S machines equipped with OCM, we prospectively studied 41 hemodialysis patients. All patients were on hemodialysis for more than three months. Pre and post dialysis urea samples were collected for estimation of single pool Kt/V and compared with OCM. Results: The average age of the patients was 56.46 ± 13.82 years and the mean duration of dialysis was 28.9 ±35.22 months. Mean blood flow rate was 309.27 ±46.06 mL/min. The mean Kt/V was 1.51 ±0.216 (<p=0.001) and the mean OCM was 1.47 ±0.191 (<p=0.001). We found a positive correlation between the two parameters i.e a Pearson’s Correlation: 0.83 (<p=0.001) and an R square value of 0.645.We found that OCM is a good indicator of Kt/V. However, it underestimated Kt/V by 2.07%±8.53%. Conclusion: Online Kt/V calculated by ionic dialysance is a useful method to estimate dialysis dose without the need of blood samples. In clinical practice Kt/V is done on a monthly basis. Any change in the dialysis prescription would entail repeat labs. OCM can be performed at each dialysis session at no extra cost and in real time. Thus, it can prove to be a helpful and economical tool in the assessment of dialysis adequacy in the low income countries with limited resources.

show abstract

“…Alternatively, an estimate of Kt/V can be obtained from dialysis machine‐measured ionic (sodium) dialysance, where the inflowing dialysis solution sodium concentration is rapidly pulsed (by changing the ratio of concentrate dilution), and the resulting change in dialysis solution conductivity across the dialyzer (downstream vs. upstream) is analyzed. While the ionic dialysance, which is mostly dependent on sodium and chloride, is closely correlated with urea clearance, the two measures are not identical, and ionic dialysance also is affected by access recirculation . In practice, the ionic dialyzer clearance (Kd‐cond) obtained in this fashion has been used to estimate Kt/V, by multiplying Kd‐cond by the dialysis session length (t), and dividing by an estimate of the urea distribution volume (V), the latter usually estimated from either anthropometry (eg, the Watson volume), or from bioimpedance, given that the urea distribution volume is closely related to the total body water .…”

Section: Introductionmentioning

confidence: 99%

“…While the ionic dialysance, which is mostly dependent on sodium and chloride, is closely correlated with urea clearance, the two measures are not identical, and ionic dialysance also is affected by access recirculation. 3 In practice, the ionic dialyzer clearance (Kd-cond) obtained in this fashion has been used to estimate Kt/V, by multiplying Kd-cond by the dialysis session length (t), and dividing by an estimate of the urea distribution volume (V), the latter usually estimated from either anthropometry (eg, the Watson volume 4 ), or from bioimpedance, 5 given that the urea distribution volume is closely related to the total body water. 6 However, this conductivity based Kt/V correlates only modestly with Kt/V derived from predialysis and postdialysis SUN measurement.…”

mentioning

confidence: 99%

Eliminating the need for routine monthly postdialysis serum urea nitrogen measurement: A method for monitoring Kt/V and normalized protein catabolic rate using conductivity determined dialyzer clearance

Daugirdas

2018

Seminars in Dialysis

View full text Add to dashboard Cite

Many dialysis machines can compute dialyzer sodium clearances at multiple time points during a dialysis treatment using conductivity. For a given treatment, the average dialyzer sodium clearance (K), when combined with treatment time (t), and the estimated urea distribution volume (V, usually based on either anthropometry or bioimpedance), can be used to estimate Kt/V, an important measure of hemodialysis adequacy. While this conductivity‐derived value for Kt/V correlates moderately with Kt/V calculated from predialysis and postdialysis serum urea nitrogen (SUN) values (urea reduction ratio, URR), the ultrafiltration volume, and session length it is, unfortunately, not sufficiently accurate to replace URR‐based Kt/V. Here we underline the potential utility of an alternative method to estimate Kt/V (a variant of a technique originally proposed by Gotch and Levin and their colleagues) using conductivity‐derived sodium clearance (K) that does not require routine measurement of the postdialysis SUN but which should closely track Kt/V computed in the usual fashion. The increased accuracy with the new method is explained by the use of a patient‐specific value of V, which is an average value calculated from several dialysis sessions where both conductivity dialyzer clearance and predialysis and postdialysis SUN have been measured. Once this patient‐specific conductivity/URR‐based value for V has been determined, it can be used to calculate Kt/V for subsequent treatments in which conductivity‐based dialyzer clearances are measured, but around which predialysis and postdialysis SUN values have not been obtained. (If the predialysis SUN values for such a subsequent treatment are also measured, then a normalized protein catabolic rate that closely tracks the value from conventional urea modeling, can also be determined.) By reducing the number of postdialysis SUN measurements needed to monitor hemodialysis adequacy this new method of estimating Kt/V by conductivity should save staff time and laboratory costs, increase patient and staff safety, and decrease error rates associated with improper postdialysis blood sampling technique.

show abstract

Online measurement of hemodialysis adequacy using effective ionic dialysance of sodium—a review of its principles, applications, benefits, and risks

Cited by 20 publications

References 34 publications

A novel method to rapidly calculate the urea clearance index and urea reduction rate based on parameters obtained during hemodialysis

A novel method to rapidly calculate the urea clearance index and urea reduction rate based on parameters obtained during hemodialysis

Assessment of hemodialysis adequacy: Correlation between online clearance monitoring and single pool Kt/V.

Eliminating the need for routine monthly postdialysis serum urea nitrogen measurement: A method for monitoring Kt/V and normalized protein catabolic rate using conductivity determined dialyzer clearance

Contact Info

Product

Resources

About