DOCSLIB.ORG

Urea Reduction Ratio May Be a Simpler Approach for Measurement of Adequacy of Intermittent Hemodialysis in Acute Kidney Injury Kelly V

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Urea Reduction Ratio May Be a Simpler Approach for Measurement of Adequacy of Intermittent Hemodialysis in Acute Kidney Injury Kelly V Liang et al. BMC Nephrology (2019) 20:82 https://doi.org/10.1186/s12882-019-1272-7 RESEARCHARTICLE Open Access Urea reduction ratio may be a simpler approach for measurement of adequacy of intermittent hemodialysis in acute kidney injury Kelly V. Liang1* , Jane H. Zhang2 and Paul M. Palevsky3 Abstract Background: Assessment of adequacy of intermittent hemodialysis (IHD) is conventionally based upon urea kinetic models for calculation of single pool Kt/Vurea (Kt/V), with 1.2 accepted as minimum adequate clearance for thrice weekly IHD. In the Acute Renal Failure Trial Network (ATN) Study, adequacy of IHD in patients with acute kidney injury (AKI) was assessed using Kt/V. However, equations for Kt/V require volume of distribution of urea, which is highly variable in AKI. Therefore, simpler methods are needed to assess adequacy of IHD in AKI. We assessed correlation of urea reduction ratio (URR) with Kt/V and determined URR thresholds corresponding to Kt/V values to determine if URR could be a simpler means to assess the delivered dose of IHD. Methods: Using patients who received IHD for 2.5–6 h and with pre-dialysis BUN ≥20 mg/dL, we plotted URR against Kt/V. We determined URR thresholds (0.60 to 0.75) corresponding to Kt/V ≥ 1.2, 1.3, and 1.4. We generated receiver operating characteristic (ROC) curves for increasing URR values for each level of Kt/V to identify the corresponding thresholds of URR. Results: There was strong correlation between URR and Kt/V. ROC curves comparing URR with Kt/V ≥ 1.2, 1.3, and 1.4 had area under the curves (AUC) of 0.99. Sensitivity and specificity of URR ≥0.67 for corresponding values of Kt/V ≥ 1.2 were 0.769 (95% CI: 0.745 to 0.793) and 0.999 (95% CI: 0.997 to 1.000), respectively and the sensitivity and specificity of URR ≥0.67 for corresponding values of Kt/V ≥ 1.4 were 0.998 (95% CI: 0.995 to 1.000) and 0.791 (95% CI: 0.771 to 0.811), respectively. Conclusions: Targeting a URR ≥0.67 provides a simplified means of assessing adequacy of IHD in patients with AKI. Use of URR will enhance ability to assess delivery of small solute clearance and improve adherence with clinical practice guidelines in AKI. Keywords: Acute kidney injury, Renal replacement therapy, Adequacy, Kt/V, Urea reduction ratio Background conventionally based upon urea kinetic models for Renal replacement therapy (RRT) is often required for calculation of single pool Kt/Vurea (Kt/V) [1–5]. The the management of acute kidney injury (AKI). Depend- Kidney Disease: Improving Global Outcomes (KDIGO) ing on hemodynamic status, RRT may be provided by Clinical Practice Guidelines for AKI recommend achiev- continuous dialysis (CRRT), hybrid forms of prolonged ing a threshold Kt/V of at least 1.3 3x/week or 3.9/week intermittent RRT (PIRRT) or intermittent dialysis (IHD). when delivering IHD in the setting of AKI [6]. These Assessment of adequacy of solute clearance in IHD is recommendations were substantially based upon data from the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network (ATN) study, a multi- * Correspondence: [email protected] 1Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh center randomized trial comparing strategies of School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213, USA more-intensive and less-intensive RRT in critically ill Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Liang et al. BMC Nephrology (2019) 20:82 Page 2 of 7 patients with AKI which targeted a delivered Kt/V of except Sunday) when hemodynamically stable. Participants 1.2–1.4 in patients receiving IHD [7]. randomized to the less-intensive strategy (N = 561) received Rigorous quantification of dialysis dose using urea CVVHDF at an effluent flow rate of 20 mL/kg/h or SLED kinetic modeling is based on assumptions related to net on a 3-day-per-week schedule (every other day except nitrogen balance and the generation and volume of dis- Sunday) when hemodynamically unstable, or IHD on a tribution of urea that are not necessarily present in the 3-day-per-week schedule (every other day except Sunday) critically ill patient with AKI [8, 9]. Patients with AKI when hemodynamically stable. In each treatment arm, IHD are often hypercatabolic and in net negative nitrogen was prescribed with a targeted single-pool, variable-volume balance; may have rates of urea that are not constant (spvv) Kt/V of 1.2–1.4 per treatment. over time; have alterations in regional blood flow, par- ticularly in the setting of hemodynamic instability, that Calculation of Kt/V may produce disequilibrium in urea distribution between Kt/V was assessed at least three times per week during body compartments, invalidating standard single-pool the first two weeks of study therapy and at least weekly models; and may have a volume of distribution of urea thereafter using the second generation logarithmic (Vurea) that is variable and increased relative to patients (Daugirdas) equation: with end-stage renal disease [5, 10, 11]. Thus, the applic- = ¼ ‐ ðÞ‐ : ability of the formal urea kinetic models and standard Kt V ln R 0 008 x t þ ðÞÀ : : = logarithmic estimating equations for calculation of Kt/V 4 3 5xR x055 x UF Vurea that were developed in the end-stage renal disease where R is the ratio of post-dialysis BUN (BUN ) setting to estimate adequacy of small solute clearance in post divided by pre-dialysis BUN (BUN ), t is the dialysis patients with AKI receiving IHD is questionable. In pre session duration in hours, UF is the ultrafiltration particular, uncertainty regarding adjustments for Vurea volume in liters, and Vurea is the estimated volume of may introduce substantial error in the calculation of Kt/ distribution of urea [8, 9]. Blood samples for BUN were V using standard estimating equations. obtained immediately pre- and post-dialysis, with the In this post hoc analysis of data from the ATN study, post-dialysis BUN sample obtained using the slow-flow/ we sought to determine if use of the urea reduction ratio stop-pump technique [14] to prevent sample dilution (URR), based only on measurement of pre- and with recirculated blood and to minimize the variable ef- post-dialysis BUN and independent of estimates of V , urea fects of urea rebound. V was initially estimated as would provide a simpler but sufficiently reliable method urea 55% of pre-morbid body weight plus edema weight, for assessment of the delivered small solute clearance where edema weight was calculated as pre-morbid body during IHD for patients with AKI. In this analysis, we weight subtracted from current body weight and was assessed the correlation between URR and the systemat- recalculated each treatment. In patients with morbid ically calculated values of Kt/V in patients undergoing obesity, defined as actual weight > 130% of ideal body IHD in the ATN Study and determined URR thresholds weight (IBW), an adjusted pre-morbid body weight was that could be used as an alternative to Kt/V to assess calculated as IBW plus 25% of the difference between small solute clearance in critically ill patients with AKI ideal and actual pre-morbid weight with IBW calculated undergoing IHD. based on height, gender, and frame size with adjustment for limb amputation [15]. The rationale for this correc- Methods tion is based on the reduction in the percentage body ATN study design weight comprised by water (and hence V ) as the In the ATN Study, 1124 critically ill adults with severe urea percentage body fat increases. AKI attributable to acute tubular necrosis in the setting of sepsis or one or more failed non-renal organ systems Calculation of urea reduction ratio (URR) were randomized to strategies of either less-intensive or The urea reduction ratio was calculated as the quotient more-intensive RRT. Details of the design and primary of the difference between the BUN and the BUN results of the ATN study have been previously published pre post divided by the BUNpre: [7]. Written informed consent was obtained prior to ÀÁ enrollment and randomization of all participants. Partic- URR ¼ BUNpre À BUNpost =BUNpre ipants randomized to more-intensive RRT (N = 563) received continuous venovenous hemodiafiltration using the same BUN values used to calculate Kt/V. (CVVHDF) at an effluent flow rate of 35 mL/kg/h or sus- tained low-efficiency dialysis (SLED) on a 6-day-per-week Statistical methods schedule (every day except Sunday) when hemodynamically We compared paired Kt/V and URR measurements from unstable, or IHD on a 6-day-per-week schedule (every day all IHD treatments with measured pre- and post-dialysis Liang et al. BMC Nephrology (2019) 20:82 Page 3 of 7 BUNs, excluding treatments that were < 2.5 h or > 6 h in Table 1 Characteristics of patients receiving intermittent duration. In addition, we excluded data from IHD hemodialysis (IHD) included in analysis treatments with pre-dialysis BUN values < 20 mg/dL as Patients receiving the reliability of URR and Kt/V calculations is markedly IHD (N = 589) reduced when the pre-dialysis BUN is < 20 mg/dL.
Load more

Recommended publications
  • Guidelines for Contributing Authors
    Charuhas V. Thakar, MD, FASN, FNKF Editor-in-Chief Professor of Medicine Director, Division of Nephrology Kidney C.A.R.E. Program (Clinical Advancement, Research & Education) 231 Albert B Sabin Way Cincinnati, OH 45267 Email: [email protected] Phone: 513-558-5471 Samantha Kramer, Managing Editor Email: [email protected] Guidelines for Contributing Authors Mission Statement The purpose of Advances in Chronic Kidney Disease (ACKD) is to provide in-depth, scholarly review articles about the care and management of persons with early kidney disease and kidney failure, as well as those at risk for kidney disease. Emphasis is on articles related to the early identification of kidney disease; prevention or delay in progression of kidney disease; the multidisciplinary case management of patients with chronic kidney disease or kidney failure; organ effects of kidney disease; epidemiology and outcomes research in kidney disease; benefits and complications of the primary treatment methods, dialysis and transplantation; technical aspects of the delivery of uremia therapy; care of the critically ill patient with kidney failure in the intensive care setting; new therapies for kidney failure; and health care research in chronic kidney disease. The full spectrum of basic science through clinical care is covered in these reviews. Clinical care issues stress the multidisciplinary team approach to the care of kidney patients. Topics covered will be of interest to practicing nephrologists (pediatric and adult), nephrology fellows (pediatric and adult), nurses, technicians, dieticians, and social workers caring for patients with kidney disease. Each issue of ACKD includes a focused review section of several articles on a topic of current interest.
    [Show full text]
  • Abbreviations
    Abbreviations AAPCC Adjusted average per capita cost CKD-EPI chronic kidney disease epidemiology calculation ACEI angiotensin-converting enzyme inhibitor CKO cytokinin oxidase ACR albumin/creatinine ratio CMS Centers for Medicare & Medicaid Services ADL activities of daily living CMV cytomegalovirus (antibody status) ADR annual data report COPD chronic obstructive pulmonary disease AF atrial fibrillation CORR Canadian Organ Replacement Register AFIB atrial fibrillation CPM clinical performance measures AFS Annual Facility Survey (CMS 2744) CPRA calculated panel reactive bodies AJKD American Journal of Kidney Disease CPT current procedure and terminology AKI acute kidney injury CrCl creatinine clearance rate AKI-D acute kidney injury with dialysis CROWNWeb Consolidated Renal Operations in a Web- AMI acute myocardial infarction Enabled Network (CROWN) Data — data collection system for ESRD dialysis ANZDATA Australia & New Zealand ESRD database facilities mandated by CMS ARB angiotensin receptor blocker CRT cardiac resynchronization ASHD atherosclerotic heart disease CVA cerebrovascular accident AV arteriovenous CVD cardiovascular disease BMI body mass index CVVHD continuous venous-to-venous hemodialysis BUN blood urea nitrogen CWF common working file CABG coronary artery bypass grafting DCD donation after circulatory death CAPD continuous ambulatory peritoneal dialysis DCI Dialysis Clinic, Inc. CBC complete blood count DFC dialysis facility compare CCPD continuous cycling peritoneal dialysis DGF delayed graft function CDC Centers for Disease
    [Show full text]
  • Cystatin C and Some Biochemical Parameters for Dialysis Adequacy Among Hemodialysed Patients at Al-Shifa Hospital, Gaza-Governorate
    الجامعةةةةةةةةةةةةةةةةةةةةة اﻹسةةةةةةةةةةةةةةةةةةةة مية بغةةةةةةةةةةةةةةةةةةةة زة The Islamic University of Gaza عمةةةةةةاحة البحةةةةةةد العلمةةةةةةي والد اسةةةةةةا العليةةةةةةةا Deanship of Research and Graduate Studies كليةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةة العلةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةو Faculty of Science Master of Biological Sciences ماجسةةةةةةةةةةةةةةةةةةتير العلةةةةةةةةةةةةةةةةةةو الحياتيةةةةةةةةةةةةةةةةةةةة Medical Technology التحةةاليةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةل الطبيةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةةة Cystatin C and Some Biochemical Parameters for Dialysis Adequacy Among Hemodialysed Patients at Al-Shifa Hospital, Gaza-Governorate سيستاتين سي وبعض المعايير البيوكيميائية لقياس كفاءة الغسيل الدموي لدى مرضى الفشل الكلوي المزمن في مستشفى الشفاء - محافظة غزة Prepared By Fawwaz H. Eliglah Supervisor Prof. Baker M. Zabut Faculty of Science Biochemistry Department The Islamic University of Gaza A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Biological Sciences- Medical Technology September , 2018 إقةةةةةةةةةةةةةةرا أنا الموقع أحناه مقد الرسالة التي تحمل العنوان: Cystatin C and Some Biochemical Parameters for Dialysis Adequacy Among Hemodialysed Patients at Al-Shifa Hospital, Gaza-Governorate سيستاتين سي وبعض المعايير البيوكيميائية لقياس كفاءة الغسيل الدموي لدى ي مرضى الفشل الكلو المزمن في مستشفى الشفاء - محافظة غزة أقر بأن ما اشتملت عليه هذه الرسالة إنما هو نتاج جهدي الخاص، باستثناء ما تمت اﻹشارة إليه حيثما ورد، وأن هذه الرسالة ككل أو أي جزء منها لم يقدم من قبل اﻻخرين لنيل درجة أو لقب علمي أو بحثي لدى أي مؤسسة تعليمية أو بحثية أخرى. Declaration I understand the nature of plagiarism, and I am aware of the University’s policy on this. The work provided in this thesis, unless otherwise referenced, is the researcher's own work, and has not been submitted by others elsewhere for any other degree or qualification. اسم الطالب: فواز حسن العجلة :Student's name التوقيع: Signature: Fawwaz H.
    [Show full text]
  • Manual of Clinical Dialysis
    Manual of Clinical Dialysis Second Edition Manual of Clinical Dialysis Second Edition Suhail Ahmad University of Washington, Scribner Kidney Center, Northwest Kidney Centers, Seattle, Washington, USA ABC Suhail Ahmad, MD Professor, Medicine University of Washington Scribner Kidney Center Northwest Kidney Centers Seattle, Washington [email protected] ISBN: 978-0-387-09650-6 e-ISBN: 978-0-387-09651-3 DOI: 10.1007/978-0-387-09651-3 Library of Congress Control Number: 2008928866 °c Springer Science+Business Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper springer.com Grateful thanks to my family, Vimli, Saba, and Zeba, and friends for their strong support and to Arlene for all of her help.
    [Show full text]
  • Kt/V Calculations for the Assessment of Hemodialysis Adequacy
    Wt 0.10 0.08 0.06 0.04 1.80 0.02 0.00 1.60 1.40 Kt/V 1.20 1.00 0.80 0.60 0.40 0.50 0.60 0.70 0.80 URR We have found that the Keshaviah Quick Kt/V formula most closely correlates with both of the more complex Kt/V calculations that Spectra offers - the Daugirdas II Natural Log and Depner Full UKM Kt/V (see Figures 2 & 3). Comparison of Kt/V Formulas to UKM Kt/V Comparison of Kt/V Formulas to UKM Kt/V 1500 Patient Results 0.6 to 2.0 2.20 2.20 2.00 2.00 1.80 1.80 1.60 1.60 1.40 1.40 1.20 Kt/V Calculations for 1.00 1.20 0.80 1.00 0.60 the Assessment of 0.40 1 4 7 0.80 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 101 103 105 107 109 111 113 115 117 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 112 115 118 100 103 106 109 121 Hemodialysis Adequacy Depner Full UKM Depner Full UKM Daugirdas II (Post BUN/Pre BUN-0.008 x t) + Daugirdas II (Post BUN/Pre BUN-0.008 x t) + Natural Log [4-3.5 x (Post BUN/Pre BUN)] x UF / Wt Natural Log [4-3.5 x (Post BUN/Pre BUN)] x UF / Wt Jindal 0.04*URR-1.2 Jindal 0.04*URR-1.2 Basile 0.023*URR-0.284 Basile 0.023*URR-0.284 Depner 0.026*URR-0.49 Depner 0.026*URR-0.49 Keshaviah 1.162*In(Pre/Pst) Keshaviah 1.162*In(Pre/Pst) Figure 2 Figure 3 References 1 Daugirdas JT: Second generation logarithmic estimates of single-pool variable volume Kt/V: An analysis of error.
    [Show full text]
  • Increasing Blood Flow Rate; a Tool to Improve Adequacy of Dialysis
    ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 9 - Issue 6 | Nov - Dec 2017 Increasing Blood Flow Rate; A Tool To Improve Adequacy Of Dialysis Aurangzeb Afzal1, Maira Iqbal Malik2, Adnan Shabbir2 ABSTRACT OBJECTIVE: To assess the effect of increasing blood flow rate on the adequacy of dialysis, and to prove that increased blood flow can be helpful in achieving adequate dose of dialysis, in patients having low efficiency of dialysis . STUDY DESIGN: Quasi experimental study PLACE AND DURATION: At Dialysis unit of Lahore General Hospital over a period of 1 month from 28th January to 28th February 2017. METHODOLOGY: A total of 40 patients on regular hemodialysis participated in this study. Hemodialysis was performed at two different blood flow speeds 300 and 350 ml/min. Blood samples were obtained just before start and 45 minutes after completion of dialysis to measure urea levels. Urea Reduction Ratio (URR) was used as an index of dialysis dose and hence dialysis efficiency. RESULT: Increasing blood flow rate from 300 to 350ml/min has a significant impact on URR and hence on dialysis adequacy. It was observed that increasing blood flow rate from 300ml/min to 350ml/min raised URR from 53% to 60%. Marked statistical difference in URR between the two groups that is 7% was observed using the paired T-test. P value was 0.001 (<0.05). CONCLUSION: Increasing blood flow rate (BFR) has been successful in boosting effective dose of dialysis and is likely to prove beneficial for patients requiring hemodialysis. KEYWORDS: Hemodialysis, Adequacy, Blood Flow Rates, Low Efficiency, Urea reduction ratio.
    [Show full text]
  • Urea Reduction Ratio (URR) for Dialysis
    Urea Reduction Ratio or URR How do I know I am getting the right amount of dialysis? The correct amount of dialysis to clear waste products from your body is called dialysis adequacy. The health care team uses many ways to find out if you are having adequate dialysis. How should I feel? When your dialysis therapy is adequate, you should have more energy. You should also sleep better and feel like eating. When your dialysis therapy needs adjusting, you may feel weak and tired. You may not sleep well. You may not feel like eating or may have an upset stomach. You may also have some swelling in the ankles or feet or have problems breathing. What is URR? One way to assess dialysis adequacy is to do a blood test called Urea Reduction Ratio or URR. This test measures a waste product called urea. A blood sample is taken before and after the dialysis treatment through the dialysis machine. The laboratory then tests the blood for urea. The results come back as a percentage of urea lowered during the dialysis treatment. The Dialysis Units do URR blood tests once a month on all dialysis patients. Your dialysis therapy will aim to give you a URR of 65% or more - the higher the number the better. This means the hemodialysis treatments are working well to get rid of waste products in your body. If your blood test result is below 65%, the doctor will assess your dialysis prescription and improve your URR. Each person will have a number that the doctor feels is right for that person.
    [Show full text]
  • Factors That Affect Postdialysis Rebound in Serum Urea Concentration, Including the Rate of Dialysis: Results from the HEMO Study
    J Am Soc Nephrol 15: 194–203, 2004 Factors that Affect Postdialysis Rebound in Serum Urea Concentration, Including the Rate of Dialysis: Results from the HEMO Study JOHN T. DAUGIRDAS, TOM GREENE, THOMAS A. DEPNER, JOHN LEYPOLDT, FRANK GOTCH, GERALD SCHULMAN, and ROBERT STAR for the Hemodialysis (HEMO) Study Group National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland Abstract. Previous studies have suggested that postdialysis was the strongest predictor of rebound among 22 factors con- urea rebound is related to K/V, the rate of dialysis, but a sidered. Other factors associated with greater rebound for 1331 systematic analysis of factors that affect rebound has not been patients using AV accesses or venous catheters included access reported. With the use of 30-min and, in a subset, 60-min type, black race, male gender, absence of congestive heart postdialysis samples, postdialysis urea rebound was measured failure, greater age, ultrafiltration rate, and low predialysis or to (1) determine how well previously proposed equations based intradialysis systolic BP. Equations of the form eKt/V ϭ on the rate of dialysis (K/V) predict rebound in a large sample single-pool Kt/V Ϫ B ϫ (K/V) were fit to the data. With AV of patients with varying characteristics, (2) determine whether access, the optimum values for the slope term (B) were 0.39 other factors besides K/V affect rebound, and (3) estimate and 0.46 (in hϪ1) for single-pool Kt/V calculated based on 20-s more precise values for coefficients in prediction equations for postdialysis or immediate postdialysis samples, respectively.
    [Show full text]
  • Hemodialysis Dose and Adequacy
    Hemodialysis Dose and Adequacy When kidneys fail, dialysis is neces­ The amount of urea removed (35 mg/dL) sary to remove waste products such as is expressed as a percentage of the pre- urea from the blood. By itself, urea is dialysis urea level (50 mg/dL). only mildly toxic, but a high urea level 35/50 = 70/100 = 70% means that the levels of many other waste products that are more harm­ Although no fixed percentage can be ful and not as easily measured are also said to represent an adequate dialysis, building up. patients generally live longer and have fewer hospitalizations if the URR is To see whether dialysis is removing at least 60 percent. As a result, some enough urea, the dialysis clinic should experts recommend a minimum URR periodically—normally once a month— of 65 percent. test a patient’s blood to measure dialysis adequacy. Blood is sampled at the start The URR is usually measured only once of dialysis and at the end. The levels of every 12 to 14 treatments, which is urea in the two blood samples are then once a month. The URR may vary con­ compared. Two methods are generally siderably from treatment to treatment. used to assess dialysis adequacy, URR Therefore, a single value below 65 per­ and Kt/V. cent should not be of great concern, but a patient’s average URR should exceed What is the URR? 65 percent. URR stands for urea reduction ratio, meaning the reduction in urea as a What is the Kt/V? result of dialysis.
    [Show full text]
  • Nkf-Doqi Clinical Practice Guidelines for Peritoneal Dialysis Adequacy
    NKF-DOQI CLINICAL PRACTICE GUIDELINES FOR PERITONEAL DIALYSIS ADEQUACY 867 Acronyms and Abbreviations Abbreviation Term ACE angiotensin-converting enzyme BSA body surface area BUN blood urea nitrogen concentration (an old term; SUN is technically correct, see below) CANUSA Canada/USA Peritoneal Dialysis Study CAPD continuous ambulatory peritoneal dialysis CCPD continuous cycling peritoneal dialysis CCr creatinine clearance CrCr residual renal creatinine clearance DI dialysis index DPI dietary protein intake eC effective clearance ESRD end-stage renal disease GFR glomerular filtration rate HD hemodialysis Kpcr peritoneal creatinine clearance KptlVurea the peritoneal component of KtIV urea KprtlVurea the sum of peritoneal and renal KtIV urea. These terms are interchangeable in that KtIVurea is total unless otherwise noted. KtlVurea urea clearance X time normalized by total body water, the volume of distribution of urea KrtlVurea the renal component of KtIV urea MTC mass transfer coefficient n normalized nBSA normalized body surface area NIPD nightly intermittent peritoneal dialysis nPCR normalized protein catabolic rate nPNA normalized protein equivalent of total nitrogen appearance nV normalized volume PCR protein catabolic rate PD peritoneal dialysis PET peritoneal equilibration test PNA protein equivalent of nitrogen appearance QOL quality of life RRF residual renal function SGA subjective global assessment SHR standardized hospitalization rates SUN serum urea nitrogen concentration t time UKM urea kinetic modeling UNA urea nitrogen appearance URR urea reduction ratio USRDS United States Renal Data System V volume of distribution. When referring to urea, this is total body water S68 Introduction This Work Group was charged with preparing purpose of these guidelines, a child was considered practice guidelines for the "adequacy of perito• to be a' patient less than 19 years of age.
    [Show full text]
  • (ESRD) Quality Measure Development and Maintenance Hemodialysis Adequacy Clinical Technical Expert Pane
    End Stage Renal Disease (ESRD) Quality Measure Development and Maintenance Hemodialysis Adequacy Clinical Technical Expert Panel Summary Report Prepared by: Arbor Research Collaborative for Health and the University of Michigan Kidney Epidemiology and Cost Center Conducted April 16-17, 2013 in Baltimore, MD Sent to CMS on June 28, 2013 Contract No. 500-2008-00022I, Task Order No. HHSM-500-T0001 1 Table of Contents Technical Expert Panel Summary .................................................................................................................. 5 1. Introduction/Background: ........................................................................................................................ 7 2. Discussion of Urea Kinetics ....................................................................................................................... 8 2.1 Standardized (Std) Kt/V ....................................................................................................................... 9 2.1.1 Literature Review & Scientific Importance .................................................................................. 9 2.1.2 Scientific acceptability: .............................................................................................................. 10 2.1.3 Feasibility and usability: ............................................................................................................. 10 2.1.4 Review of existing measures: ....................................................................................................
    [Show full text]
  • Just the Facts: Getting Enough Hemodialysis
    Just the Facts: Getting Enough Hemodialysis What is adequate dialysis? should be 65% or higher to be sure you are getting enough dialysis. Your doctor Healthy kidneys work 24 hours a day, 7 should prescribe a URR of 70% or higher days a week. When kidneys stop working, to be sure your URR is at least 65%. Ask dialysis does s o m e of this work. A d e q u a t e about your URR level. dialysis means enough treatment to help you live long and well. What is Kt/V? Dialysis is measured in a dose, like a dose K t / V ( k a y - t e e - o v e r-vee) is another way to of medicine. Your doctor will prescribe a measure the dose of dialysis. Kt/V m e a s u r e s dose of dialysis that should keep you clearance, or “K,” (urea and other waste feeling well. Your URR or Kt/V score will removal) of the dialyzer. Time, how long tell you if you are getting enough treatment. each treatment lasts, is the “t.” “V” is the volume of fluid in your body. Your Kt/V should be 1.2 or higher to be sure you are getting enough dialysis. Your doctor should prescribe a Kt/V of at least 1.3 to be sure that your Kt/V is at least 1.2. Ask about your Kt/V level. Why is getting enough hemodialysis important to me? If you do not get enough dialysis, you will feel ill.
    [Show full text]