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Mathematical Modeling of Dialysis
Published in Sirshendu De, Anirban Roy, Hemodialysis Membranes, 2017
To understand the drop in urea concentration in blood, the standard method is to sample blood at 30 and 60 minutes after a dialysis session.37 However, this may pose a problem and indeed there are various practical issues. The main problem lies in the fact that Kt/V is overestimated by measuring the pre- and postdialysis blood urea concentrations. This phenomenon is also known as postdialysis urea rebound (PDUR). This is due to the intercompartmental equilibration of urea (in line with the double-pool model) occurring 30–90 minutes after standard hemodialysis sessions38,39 or 60 minutes after 8-hour-long hemodialysis sessions40; 12%–40% error in judgment of dialysis adequacy occurs if PDUR is ignored. A solution to this problem, keeping practicality in mind, was suggested by Smye et al.39:where is the Smye relation for equilibrated postdialysis BUNC0 is the predialysis BUNCs is the middialysis BUN (usually after 70 minutes of hemodialysis)Ct is BUN concentration at the end of hemodialysistd is the duration of hemodialysists is the sampling time of Cs Hence, PDUR is expressed as
Outcomes and Economics of ESRF
Published in Meguid El Nahas, Kidney Diseases in the Developing World and Ethnic Minorities, 2005
Eduardo Lacson Jr, Martin K. Kuhlmann, Nathan W. Levin, Kunal Shah, Maki Yoshino
Among surrogate outcomes such as dialysis adequacy, the DOPPS had spKt/V of 1.3 among all continents, thus negating any comparisons (54). When the data were pooled, it raised some concern about the potential need for higher dialysis dose for women (55), consistent with the findings from the recently concluded HEMO study (56). For developing countries like India, for example, Kt/V is often not measured or if done, results show that many patients have spKt/V <1.0 (3). Again, the main concern in developing countries is the provision of HD, sometimes to alleviate emergent fluid or electrolyte problems and with less emphasis on laboratory-based adequacy measurements. There was a large variation between the DOPPS countries when considering anemia management (57). However, there is little to add to currently existing clinical practice guidelines except perhaps to encourage judicious iron replacement (35–40% had transferring saturation <10%) and maintenance of a high index of clinical suspicion for other sources of blood loss or covert infection/inflammation. The findings confirmed that the wide standard deviations of the hemoglobin values made it very difficult to keep hemoglobin within the narrow 11–12 mg/dL range recommended by the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for anemia management (58), consistent with data from Ref. 59. The relevance of this finding to the developing world rests mostly in the lack of funds for the procurement of erythropoietin. The potential need for erythropoietin can be exponentially grown if the access to RRT continues to grow. However, as in the case of India, the cost of erythropoietin may be twice that of the HD treatment itself (3). Medications are often not reimbursed in developing countries and these become out-of-pocket expenses. Therefore, given the choice, most patients would rather save any spare funds to pay for future HD therapy rather than pay for a single dose of erythropoietin, with uncertainty as to when they can get funds for the next dose.
Kt/V reach rate is associated with clinical outcome in incident peritoneal dialysis patients
Published in Renal Failure, 2022
Shuang Liu, Lijie Zhang, Shuang Ma, Jing Xiao, Dong Liu, Rui Ding, Zhengyan Li, Zhanzheng Zhao
There are several possible reasons for the relationship between Kt/V and prognosis. First, Kt/V is an important quantitative index to evaluate small solute clearance, and is known as one of the major determinants of dialysis adequacy. Second, Kt/V has a protective effect on RRF preservation [16]. Patients with better RRF have a better prognosis [17]. Third, it has been reported that high Kt/V can reduce the incidence of peritonitis [8]. Peritonitis is a major cause of death and technique failure in PD patients. Fourth, Kt/V is inversely correlated with over-hydration [18], promoting the removal of fluid and sodium. Last but not least, there is a positive association between Kt/V and hemoglobin [16], which can improve the prognosis. Unfortunately, we did not see a difference in clinical outcome between the lower-rate group and the higher-rate group. A plausible explanation is that good clinical status weakens the effect of Kt/V on prognosis, since there was no difference in clinical indicators between the two groups except BMI, creatinine, and RRF (data not shown).
Usefulness of prolonged renal replacement therapy in patients with acute kidney injury requiring dialysis
Published in Baylor University Medical Center Proceedings, 2020
Paula Duran, Luis A. Concepcion
One problematic issue with AKI RRT is the measurement of the dialysis dose. There is no general agreement as to what method to use or what values to use. In this study, the standard measurement of dialysate flow and ultrafiltration were used to calculate the dose of dialysis in mL/kg/h. Our protocol requires measuring pre and post BUN in all dialysis treatments. Based on these values, we calculated the usual measures used for chronic hemodialysis, which include urea reduction ratio, single pool and standardized KT/V, and EKR. The CVVHD dose expressed in mL/kg/h was higher than the accepted 20 to 25 mL/kg/h, but the treatment was short, reflecting also the higher dialysate flow described above. In term of the usual urea reduction ratio and single pool KT/V, the average value obtained was similar to previous studies that showed benefit.11 Extrapolating the urea kinetics for more frequent dialysis, the standardized KT/V value was acceptable and higher than the number recommended for more frequent dialysis in end-stage renal disease patients. This study also calculated the EKR,12 which is used to compare small solute clearance between continuous and intermittent therapies to achieve metabolic control. The values obtained were consistent with those of previous studies.
Association between low serum prealbumin levels and carpal tunnel syndrome in maintenance hemodialysis patients
Published in Renal Failure, 2020
Nguyen Huu Dung, Nguyen Duc Loc, Dao Bui Quy Quyen, Nguyen Minh Tuan, Pham Ngoc Huy Tuan, Do Quyet, Le Viet Thang
There were 678 patients on prevalent hemodialysis (hemodialysis duration >3 months) who joined in our study at Hemodialysis Center, Bach Mai Hospital, Ha Noi, Viet Nam, as of March 2016. Of these, patients with acute illness, significant infection, malignancy, diagnosed CTS before chronic kidney disease, or used high-flux dialyzer were excluded. The remaining patients, including 373 prevalent hemodialysis patients, provided informed consent prior to participation in our study. The enrolled patients were treated with stable, regular hemodialysis using bicarbonate dialysate. Our dialysis program used a low-flux membrane (Polyflux 14 L) as a standard. Kt/V was calculated according to the formula of Daugirdas [17]. Each dialysis session was between 3.5 and 4.5 h to achieve the target total Kt/V of approximately 1.2 per session for thrice weekly treatments. Dialyzer was reused 6 times in all patients (the procedure is regulated by Vietnam's Ministry of Health) as followings. Reuse of dialyzer is performed by a professional, trained technician. After completing the dialysis session, the dialyzer is immediately transferred to the washing room. The dialyzer is cleaned by hand using RO water for 30 min. Next, the dialyzer is soaked and disinfected with 0.7% Peracetic acid solution and stored in a professional refrigerator at a temperature of 2–8 degrees C. Before use in the dialysis patient, the dialyzer is washed again with RO water for 30 min, and the lack of Peracetic acid in the dialyzer is confirmed using a Peracetic acid 2000 test strip.