Document Detail


Ionic dialysance and the assessment of Kt/V: the influence of different estimates of V on method agreement.
MedLine Citation:
PMID:  17550929     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ionic dialysance was recently introduced as a means to assess Kt/V (K(ID)t/V). With this method, urea distribution volume (V) has to be estimated. The primary aim of the present study was to assess the agreement between equilibrated Kt/V assessed by urea kinetic modelling (eKt/V) with K(ID)t/V taking into account different estimates of V, and to assess the monthly variation in V. Secondly, the mechanisms behind the intra-treatment changes in ionic dialysance and inter-treatment variability of K(ID)t/V were assessed. METHODS: Sixty-six patients were included. eKt/V was estimated using 30 min post-treatment sampling in the second generation Daugirdas equation. V was assessed by the formulae of Watson and Chertow (V(Watson); V(Chertow)), double-pool urea kinetic modelling (V(UKM)) and by ionic dialysance (V(IOD)) [Diascan; Hospal(R)]. RESULTS: The use of V(UKM) or V(IOD) instead of V(Watson) or V(Chertow) improved the relation between eKt/V and K(ID)t/V (both r = 0.93; P < 0.001 vs r = 0.84 and r = 0.81; P < 0.001). Mean values of eKt/V (1.19 +/- 0.21), K(ID)t/V(UKM) (1.19 +/- 0.30) and K(ID)t/V(IOD) (1.21 +/- 0.25) were comparable. Intra-class correlation coefficient of V(IOD) was 0.87 with a 1-month interval and <0.75 after 2 and 3 months. Intra-class correlation coefficient of V(DP) was 0.79 with a 1-month interval and <0.75 after 2 and 3 months. Inter-treatment variation in K(ID)t/V during six consecutive dialysis sessions was 6.1% +/- 0.6%. Changes in blood flow were the main determinant of variations in K(ID)t/V (P < 0.05). During treatment, ionic dialysance decreased by 12 +/- 13 ml/min (P < 0.001). The decline in blood volume was the major determinant of the intra-dialytic change in ionic dialysance (P < 0.05). CONCLUSION: The use of V(IOD) and V(UKM) results in better agreement between eKt/V and K(ID)t/V compared with anthropometric formulae. K(ID)t/V was comparable with eKt/V and thus lower than expected for a single-pool method. V(IOD) and V(UKM), should be assessed at least monthly. K(ID)t/V varies widely between consecutive dialysis sessions, mainly due to differences in blood flow. During treatment, ionic dialysance decreases, which is related to the relative decline in blood volume.
Authors:
Karin Moret; Charles H Beerenhout; A Warmold L van den Wall Bake; Paul G Gerlag; Frank M van der Sande; Karel M Leunissen; Jeroen P Kooman
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Publication Detail:
Type:  Journal Article     Date:  2007-06-05
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  22     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-26     Completed Date:  2007-11-07     Revised Date:  2008-02-28    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2276-82     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Female
Glomerular Filtration Rate
Humans
Ions / chemistry*
Kidney / metabolism,  physiology
Kinetics
Male
Models, Statistical
Models, Theoretical
Reproducibility of Results
Time Factors
Urea / chemistry
Chemical
Reg. No./Substance:
0/Ions; 57-13-6/Urea
Comments/Corrections
Erratum In:
Nephrol Dial Transplant. 2007 Dec;22(12):3692

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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