The Urea Reduction Ratio and Serum Albumin Concentration as Predictors of Mortality in Patients Undergoing Hemodialysis

Owen, William F.; Lew, Nancy L.; Liang, Yan; Lowrie, Edmund G.; Lazarus, J. Michael

doi:10.1056/nejm199309303291404

Cited by 1,269 publications

(670 citation statements)

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“…The present NECOSAD analysis did not indicate that treatment duration itself may contribute to patient survival, which is in accordance with some other reports (1)(2)(3)7,33). However, an important drawback of the observational NECOSAD study is the restriction to treatment characteristics that are usually present in current dialysis practice.…”

Section: Discussionsupporting

confidence: 93%

“…Our finding of a positive association between delivered urea clearance and patient outcome confirms many other studies (3)(4)(5)(6)(7)(8)(9). However, the existence of and the definition of the threshold dKt/V urea level beyond which there is no further benefit in patient outcome remains a matter of debate.…”

Section: Discussionsupporting

confidence: 91%

“…A delivered Kt/V urea Ͻ0.8/session in a thrice-weekly schedule was associated with a higher morbidity, whereas an increase in the range 0.9 to 1.5/session did not lead to a further improvement in patient outcome. Other studies thereafter indicated higher threshold values for the delivered Kt/V urea (3,7,16). For example, Gotch et al (16), using data from two large U.S. databases, found a steep decline in mortality when the dialysis dose was increased up to an equilibrated Kt/V urea of 1.05/session (which is approximately similar to a single-pool Kt/V urea of 1.2/session and a urea reduction ratio of 65%).…”

Section: Discussionmentioning

confidence: 93%

“…In various studies, it was found that the Kt/V urea (or the urea reduction ratio as equivalent parameter) is an important predictor of morbidity and mortality (3)(4)(5)(6)(7)(8)(9). In the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NFK-DOQI) guidelines (1997), new high clearance targets in terms of delivered Kt/V urea were advocated (10).…”

mentioning

confidence: 99%

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Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

Termorshuizen

Dekker²,

Manen³

et al. 2004

Journal of the American Society of Nephrology

312

263

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Abstract.A high delivered Kt/V urea (dKt/V urea ) is advocated in the U.S. National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines on hemodialysis (HD) adequacy, irrespective of the presence of residual renal function. The contribution of treatment adequacy and residual renal function to patient survival was investigated. The Netherlands Cooperative Study on the Adequacy of Dialysis is a prospective multicenter study that includes incident ESRD patients older than 18 yr. The longitudinal data on residual renal function and dialysis adequacy of patients who were treated with HD 3 mo after the initiation of dialysis (n ϭ 740) were analyzed. The mean renal Kt/V urea (rKt/V urea ) at 3 mo was 0.7/wk (SD 0.6) and the dKt/V urea at 3 mo was 2.7/wk (SD 0.8). Both components of urea clearance were associated with a better survival (for each increase of 1/wk in rKt/V urea , relative risk of death ϭ 0.44 [P Ͻ 0.0001]; dKt/V urea , relative risk of death ϭ 0.76 [P Ͻ 0.01]). However, the effect of dKt/V urea on mortality was strongly dependent on the presence of rKt/V urea , low values for dKt/ V urea of Ͻ2.9/wk being associated with a significantly higher mortality in anuric patients only. Furthermore, an excess of ultrafiltration in relation to interdialytic weight gain was associated with an increase in mortality independent of dKt/V urea . In conclusion, residual renal clearance seems to be an important predictor of survival in HD patients, and the dKt/V urea should be tuned appropriately to the presence of renal function. Further studies are required to substantiate the important role of fluid balance in HD adequacy.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

See 2 more Smart Citations

Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

Termorshuizen

Dekker²,

Manen³

et al. 2004

Journal of the American Society of Nephrology

312

263

View full text Add to dashboard Cite

show abstract

“…What constitutes an "optimal" dose of dialysis, above which no further improvement in survival or well-being can be achieved, is not known. Retrospective data show that survival rates do not rise as the urea-reduction ratio rises above 70 percent, or as KT/V rises above 1.3 [29,30].…”

Section: Renal Replacement Therapy (Rrt)mentioning

confidence: 95%