Residual renal function in incremental haemodialysis

Vartia, Aarne

doi:10.1093/ckj/sfy116

Cited by 2 publications

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“…An alternative method adapted from the Casino and Basile concept adjusts the renal component of EKR/V:

EKR / V_{a} = EKR / V_{d} + AC \times K_{rf}

where AC is the K r adjusting coefficient. The adjusted total EKR/V (EKR/V a ) is compared to the EKR/V target.…”

Section: Methodsmentioning

confidence: 99%

“…EKR/V a is a therapeutic index like stdK/V and stdKt/V Dau , not a formally correct urea clearance measure. Calculation of stdK/V d and EKR/V d is described elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…The model was used for evaluating the role of RRF in incremental dialysis, but the optimization procedure was not described in detail . The current article is a technical report introducing a method for generating HD prescriptions automatically for all patients.…”

Section: Methodsmentioning

confidence: 99%

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Automatic hemodialysis prescriptions by urea kinetic modeling

Vartia

2019

Hemodialysis International

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Introduction Guidelines on hemodialysis (HD) dosing are based on urea kinetics, which can be modeled mathematically. Different schedules can be compared by equivalent continuous clearance. Methods A computer program generating HD prescriptions automatically was developed. In 200 actual HD urea kinetic modeling sessions involving 33 patients the urea distribution volume, generation rate, and concentration profile in the external space were computed using ionic dialysance as dialyzer clearance in the double pool ureakinetic model. Dialyzer in vivo mass area coefficient K0A was calculated from online data with the Michaels’ equation. Data from the modeling sessions were used for generating new prescriptions for the same patients. Findings New prescriptions meeting 12 criteria—technical limits and guideline targets—were generated by the model. They showed a wide range of basic treatment parameters (time and frequency, blood and dialysate flow, and ultrafiltration). In five cases, the dialysis time or frequency should have been increased from the actual to achieve the targets, in 72 cases the frequency could have been decreased. Two methods to emphasize RRF were tested. Using a coefficient of 2.0 for renal urea clearance in computing adjusted equivalent continuous clearance (EKR/Va), as suggested by Casino and Basile, decreased further the required treatment frequency in incremental dialysis. Discussion The model produced plausible individual prescriptions, but some unknown factors caused the determination of the dialyzer in vivo K0A to be inaccurate. The model must be tested with modern devices on patients before integration into dialysis machines and information systems.

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“…An alternative method adapted from the Casino and Basile concept adjusts the renal component of EKR/V:

EKR / V_{a} = EKR / V_{d} + AC \times K_{rf}

where AC is the K r adjusting coefficient. The adjusted total EKR/V (EKR/V a ) is compared to the EKR/V target.…”

Section: Methodsmentioning

confidence: 99%

“…EKR/V a is a therapeutic index like stdK/V and stdKt/V Dau , not a formally correct urea clearance measure. Calculation of stdK/V d and EKR/V d is described elsewhere …”

Section: Methodsmentioning

confidence: 99%

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Automatic hemodialysis prescriptions by urea kinetic modeling

Vartia

2019

Hemodialysis International

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“…They allow different renal replacement modalities and schedules to be compared directly. The article by Vartia [ 14 ] in this issue provides a rational basis for achieving this. Vartia’s solution has extended an online resource developed by Daugirdas [ 15 ].…”

Section: Converting Clearance Of Intermittent Haemodialysis To a Contmentioning

confidence: 99%

“…Instead, Vartia [ 14 ] proposes an adjustment factor to give more weight to the renal function when compared with dialysis. Using Vartia’s method, the renal function component of std Kt/V or EKR is multiplied by an adjustment factor, so higher values are calculated when there is significant renal function.…”

Section: Adjusting Renal Urea Clearance To Better Reflect Its Relativmentioning

confidence: 99%

Residual renal function in incremental dialysis

Tattersall

2018

Clinical Kidney Journal

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Incremental haemodialysis has the potential to allow better preservation of renal function, is less invasive to the patient and has lower cost. Despite these advantages, it is not commonly applied. This may be due to uncertainty about how to account for renal function in the prescription of dialysis and measurement of dose. In this issue, Vartia describes the practical basis for including the effect of renal function in the prescription and quantification of dialysis. He uses a well-known and validated urea kinetic model to calculate time average urea concentrations and the equivalent renal clearance (EKR) from dialysis. The effect of renal function is amplified by a weighting factor to account for the relatively greater effect of renal function compared with dialysis with the same urea clearance. In that way, patients on differing dialysis regimens can be dialysed with the same target dose.A further step would be to use a downward adjusting factor for dialysis to convert the urea clearance by dialysis (as EKR) to a glomerular filtration rate (GFR) equivalent. A factor of 0.75 is suggested. In that way, dialysis dose can be reported as GFR equivalent in mL/min/1.73 m2, comparable between different types of dialysis and also to renal function without dialysis.

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Residual renal function in incremental haemodialysis

Cited by 2 publications

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Automatic hemodialysis prescriptions by urea kinetic modeling

Automatic hemodialysis prescriptions by urea kinetic modeling

Residual renal function in incremental dialysis

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