Measurement of the delivery of dialysis in acute renal failure

James A. Evanson, T. Alp Ikizler, Rebecca Wingard, Stephanie Knights, Yu Shyr, Gerald Schulman, Jonathan Himmelfarb, Raymond M. Hakim

Research output: Contribution to journalArticle

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Abstract

Background. Recent studies in patients with acute renal failure (ARF) have shown a relationship between the delivered dose of dialysis and patient survival. However, there is currently no consensus on the appropriate method to measure the dose of dialysis in ARF patients. In this study, the dose of dialysis was measured by blood- and dialysate-based kinetic methods in a group of ARF patients who required intermittent hemodialysis. Methods. Treatments were performed using a Fresenius 2008E volumetric hemodialysis machine with the ability to fractionally collect the spent dialysate. Single- , double-pool, and equilibrated Kt/V were determined from the pre-, immediate post-, and 30-minute post-blood urea nitrogen (BUN) measurements. The solute reduction index was determined from the collected dialysate, as well as the single- and double-pool Kt/V. Results. Forty-six treatments in 28 consecutive patients were analyzed. The mean prescribed Kt/V (1.11 ± 0.32) was significantly greater than the delivered dose estimated by single-pool (0.96 ± 0.33), equilibrated (0.84 ± 0.28), and double-pool (0.84 ± 0.30) Kt/V (compared with prescribed, each P < 0.001). There was no statistical differences between the equilibrated and double-pool Kt/V (P = NS). The solute removal index, as determined from the dialysate, corresponded to a Kt/V of 0.56 ± 0.27 and was significantly lower than the single-pool and double-pool Kt/V (each P < 0.001). Conclusion. Blood-based kinetics used to estimate the dose of dialysis in ARF patients on intermittent hemodialysis provide internally consistent results. However, when compared with dialysate- side kinetics, blood-based kinetics substantially overestimated the amount of solute (urea) removal.

Original languageEnglish
Pages (from-to)1501-1508
Number of pages8
JournalKidney international
Volume55
Issue number4
DOIs
Publication statusPublished - 1999 Jan 1

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Acute Kidney Injury
Dialysis Solutions
Dialysis
Renal Dialysis
Blood Urea Nitrogen
Urea
Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Evanson, J. A., Ikizler, T. A., Wingard, R., Knights, S., Shyr, Y., Schulman, G., ... Hakim, R. M. (1999). Measurement of the delivery of dialysis in acute renal failure. Kidney international, 55(4), 1501-1508. https://doi.org/10.1046/j.1523-1755.1999.00355.x
Evanson, James A. ; Ikizler, T. Alp ; Wingard, Rebecca ; Knights, Stephanie ; Shyr, Yu ; Schulman, Gerald ; Himmelfarb, Jonathan ; Hakim, Raymond M. / Measurement of the delivery of dialysis in acute renal failure. In: Kidney international. 1999 ; Vol. 55, No. 4. pp. 1501-1508.
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Evanson, JA, Ikizler, TA, Wingard, R, Knights, S, Shyr, Y, Schulman, G, Himmelfarb, J & Hakim, RM 1999, 'Measurement of the delivery of dialysis in acute renal failure', Kidney international, vol. 55, no. 4, pp. 1501-1508. https://doi.org/10.1046/j.1523-1755.1999.00355.x

Measurement of the delivery of dialysis in acute renal failure. / Evanson, James A.; Ikizler, T. Alp; Wingard, Rebecca; Knights, Stephanie; Shyr, Yu; Schulman, Gerald; Himmelfarb, Jonathan; Hakim, Raymond M.

In: Kidney international, Vol. 55, No. 4, 01.01.1999, p. 1501-1508.

Research output: Contribution to journalArticle

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AU - Evanson, James A.

AU - Ikizler, T. Alp

AU - Wingard, Rebecca

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AU - Shyr, Yu

AU - Schulman, Gerald

AU - Himmelfarb, Jonathan

AU - Hakim, Raymond M.

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N2 - Background. Recent studies in patients with acute renal failure (ARF) have shown a relationship between the delivered dose of dialysis and patient survival. However, there is currently no consensus on the appropriate method to measure the dose of dialysis in ARF patients. In this study, the dose of dialysis was measured by blood- and dialysate-based kinetic methods in a group of ARF patients who required intermittent hemodialysis. Methods. Treatments were performed using a Fresenius 2008E volumetric hemodialysis machine with the ability to fractionally collect the spent dialysate. Single- , double-pool, and equilibrated Kt/V were determined from the pre-, immediate post-, and 30-minute post-blood urea nitrogen (BUN) measurements. The solute reduction index was determined from the collected dialysate, as well as the single- and double-pool Kt/V. Results. Forty-six treatments in 28 consecutive patients were analyzed. The mean prescribed Kt/V (1.11 ± 0.32) was significantly greater than the delivered dose estimated by single-pool (0.96 ± 0.33), equilibrated (0.84 ± 0.28), and double-pool (0.84 ± 0.30) Kt/V (compared with prescribed, each P < 0.001). There was no statistical differences between the equilibrated and double-pool Kt/V (P = NS). The solute removal index, as determined from the dialysate, corresponded to a Kt/V of 0.56 ± 0.27 and was significantly lower than the single-pool and double-pool Kt/V (each P < 0.001). Conclusion. Blood-based kinetics used to estimate the dose of dialysis in ARF patients on intermittent hemodialysis provide internally consistent results. However, when compared with dialysate- side kinetics, blood-based kinetics substantially overestimated the amount of solute (urea) removal.

AB - Background. Recent studies in patients with acute renal failure (ARF) have shown a relationship between the delivered dose of dialysis and patient survival. However, there is currently no consensus on the appropriate method to measure the dose of dialysis in ARF patients. In this study, the dose of dialysis was measured by blood- and dialysate-based kinetic methods in a group of ARF patients who required intermittent hemodialysis. Methods. Treatments were performed using a Fresenius 2008E volumetric hemodialysis machine with the ability to fractionally collect the spent dialysate. Single- , double-pool, and equilibrated Kt/V were determined from the pre-, immediate post-, and 30-minute post-blood urea nitrogen (BUN) measurements. The solute reduction index was determined from the collected dialysate, as well as the single- and double-pool Kt/V. Results. Forty-six treatments in 28 consecutive patients were analyzed. The mean prescribed Kt/V (1.11 ± 0.32) was significantly greater than the delivered dose estimated by single-pool (0.96 ± 0.33), equilibrated (0.84 ± 0.28), and double-pool (0.84 ± 0.30) Kt/V (compared with prescribed, each P < 0.001). There was no statistical differences between the equilibrated and double-pool Kt/V (P = NS). The solute removal index, as determined from the dialysate, corresponded to a Kt/V of 0.56 ± 0.27 and was significantly lower than the single-pool and double-pool Kt/V (each P < 0.001). Conclusion. Blood-based kinetics used to estimate the dose of dialysis in ARF patients on intermittent hemodialysis provide internally consistent results. However, when compared with dialysate- side kinetics, blood-based kinetics substantially overestimated the amount of solute (urea) removal.

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Evanson JA, Ikizler TA, Wingard R, Knights S, Shyr Y, Schulman G et al. Measurement of the delivery of dialysis in acute renal failure. Kidney international. 1999 Jan 1;55(4):1501-1508. https://doi.org/10.1046/j.1523-1755.1999.00355.x