Post to Predialysis Plasma Urea Nitrogen Ratio, Ultrafiltration and Weight to Estimate K·t/V

Manahan, Ferdinand J.; Ramanujam, Lakshmi S.; Ajam, Maher; Ing, Todd S.; Gandhi, Vasant C.; Daugirdas, John T.

doi:10.1097/00002480-198907000-00109

Cited by 8 publications

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“…This has led to a huge demand on resources for the diagnosis of new cases and for monitoring those already diagnosed with CKD [3]. Currently, diagnosis and monitoring are carried out mainly by measuring blood urea and creatinine, both small water‐soluble uraemic retention solutes [4–6]. This requires frequent blood sampling, necessitating the presence of a trained healthcare professional and causing significant pain, discomfort and inconvenience for the patient.…”

Section: Introductionmentioning

confidence: 99%

“…In the latter stages of CKD, weekly attendances may be necessary as the need to commence dialysis may not be otherwise predictable [6]. For those already on dialysis, frequent monitoring of blood urea is also performed to determine the efficacy of the treatment [5]. This requires the attendance of a healthcare professional or necessitates an outpatient clinic visit, particularly cumbersome for patients in the community such as those on home‐based therapies or with a functioning transplant.…”

Section: Introductionmentioning

confidence: 99%

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Reverse iontophoresis of urea in health and chronic kidney disease: a potential diagnostic and monitoring tool?

Ebah

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Sayce

et al. 2012

Eur J Clin Investigation

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BackgroundPatients with chronic kidney disease (CKD) need regular monitoring, usually by blood urea and creatinine measurements, needing venepuncture, frequent attendances and a healthcare professional, with significant inconvenience. Noninvasive monitoring will potentially simplify and improve monitoring. We tested the potential of transdermal reverse iontophoresis of urea in patients with CKD and healthy controls.MethodsUsing a MIC 2® Iontophoresis Controller, reverse iontophoresis was applied on the forearm of five healthy subjects (controls) and 18 patients with CKD for 3–5 h. Urea extracted at the cathode was measured and compared with plasma urea.ResultsReverse iontophoresis at 250 μA was entirely safe for the duration. Cathodal buffer urea linearly correlated with plasma urea after 2 h (r = 0·82, P < 0·0001), to 3·5 h current application (r = 0·89, P = 0·007). The linear equations y = 0·24x + 1 and y = 0·21x + 4·63 predicted plasma urea (y) from cathodal urea after 2 and 3 h, respectively. Cathodal urea concentration in controls was significantly lower than in patients with CKD after a minimum current application of 2 h (P < 0·0001), with the separation between the two groups becoming more apparent with longer application (P = 0·003). A cathodal urea cut-off of 30 μM gave a sensitivity of 83·3% and positive predictive value of 87% CKD. During haemodialysis, the fall in cathodal urea was able to track that of blood urea.ConclusionReverse iontophoresis is safe, can potentially discriminate patients with CKD and healthy subjects and is able to track blood urea changes on dialysis. Further development of the technology for routine use can lead to an exciting opportunity for its use in diagnostics and monitoring.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%