Tags

Type your tag names separated by a space and hit enter

Comparison of alternative methods for scaling dialysis dose.
Nephrol Dial Transplant. 2010 Apr; 25(4):1232-9.ND

Abstract

BACKGROUND

Kt/Vurea was established as an index of haemodialysis (HD) adequacy. The use of Vurea as a normalizing factor has been questioned, and alternative parameters such as body weight(0.67) (W(0.67)), body surface area (BSA), resting energy expenditure (REE), high metabolic rate organ (HMRO) mass, liver size (LV) and more recently, bioelectrical resistance (R), an independent and directly measurable biological parameter, were proposed as alternative methods for scaling dialysis dose.

METHODS

The present study aimed to prospectively evaluate the predictive power of some demographic, anthropometric, bioelectrical (BIA) and biochemical parameters, of seven scaling parameters, namely Vurea, as derived from the Watson et al. formulae, W(0.67), BSA, REE, HMRO, LV and R and of eight HD adequacy indices [single-pool variable-volume Kt/Vurea, computed using the Daugirdas equation, its rescaled equivalents (Kt/W(0.67), Kt/BSA, Kt/REE, Kt/HMRO, Kt/LV and Kt/R) and Kt] on long-term survival of a cohort of 328 incident white HD patients. All individuals underwent periodical (every 3 months) biochemical evaluations and single-frequency BIA measurements, injecting 800 microA at 50 kHz alternating sinusoidal current with a standard tetrapolar technique.

RESULTS

A first Cox regression analysis, testing the predictive power of some demographic, anthropometric, BIA and biochemical parameters, and of the eight HD adequacy indices on long-term survival of the patients, showed that only higher serum creatinine (Scr) levels (P < 0.0001) and lower Kt/R values (P < 0.04) were significant outcome predictors. As Kt was shown not to be an outcome predictor, a second Cox regression analysis, testing the predictive power of the same demographic, anthropometric, BIA and biochemical parameters, and of the seven scaling parameters on long-term survival of the patients, was built. It showed that only higher Scr levels (P < 0.0001) and higher R values (P < 0.04) were significant outcome predictors. Kaplan-Meier survival analyses of the patients stratified into two groups, respectively, according to the first quartile of R values (0.0-467.8 Ohm), the fourth quartile of Kt/R values (98-106 ml/Ohm) and the first quartile of Scr levels (0.0-11.6 mg/dl) showed a significantly higher long-term survival in the groups of patients having R values above the first quartile (P < 0.04), Kt/R values below the fourth quartile (P < 0.03) and Scr levels above the first quartile (P < 0.0001).

CONCLUSIONS

Kt/R, R and Scr were independent significant predictors of long-term-survival in incident HD patients: R is related to the fluid status, whereas Scr, which reflects the lean body mass, seems to suggest that body composition is more important than body weight and/or body mass index. Further work is required to develop these concepts and to translate them into rigorous outcome-based adequacy targets suitable for clinical usage.

Authors+Show Affiliations

Nephrology and Dialysis Units, "Miulli" General Hospital, Acquaviva delle Fonti, Italy. basile.miulli@libero.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20007130

Citation

Basile, Carlo, et al. "Comparison of Alternative Methods for Scaling Dialysis Dose." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 25, no. 4, 2010, pp. 1232-9.
Basile C, Vernaglione L, Lomonte C, et al. Comparison of alternative methods for scaling dialysis dose. Nephrol Dial Transplant. 2010;25(4):1232-9.
Basile, C., Vernaglione, L., Lomonte, C., Bellizzi, V., Libutti, P., Teutonico, A., & Di Iorio, B. (2010). Comparison of alternative methods for scaling dialysis dose. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 25(4), 1232-9. https://doi.org/10.1093/ndt/gfp603
Basile C, et al. Comparison of Alternative Methods for Scaling Dialysis Dose. Nephrol Dial Transplant. 2010;25(4):1232-9. PubMed PMID: 20007130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of alternative methods for scaling dialysis dose. AU - Basile,Carlo, AU - Vernaglione,Luigi, AU - Lomonte,Carlo, AU - Bellizzi,Vincenzo, AU - Libutti,Pasquale, AU - Teutonico,Annalisa, AU - Di Iorio,Biagio, Y1 - 2009/12/08/ PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/8/18/medline SP - 1232 EP - 9 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 25 IS - 4 N2 - BACKGROUND: Kt/Vurea was established as an index of haemodialysis (HD) adequacy. The use of Vurea as a normalizing factor has been questioned, and alternative parameters such as body weight(0.67) (W(0.67)), body surface area (BSA), resting energy expenditure (REE), high metabolic rate organ (HMRO) mass, liver size (LV) and more recently, bioelectrical resistance (R), an independent and directly measurable biological parameter, were proposed as alternative methods for scaling dialysis dose. METHODS: The present study aimed to prospectively evaluate the predictive power of some demographic, anthropometric, bioelectrical (BIA) and biochemical parameters, of seven scaling parameters, namely Vurea, as derived from the Watson et al. formulae, W(0.67), BSA, REE, HMRO, LV and R and of eight HD adequacy indices [single-pool variable-volume Kt/Vurea, computed using the Daugirdas equation, its rescaled equivalents (Kt/W(0.67), Kt/BSA, Kt/REE, Kt/HMRO, Kt/LV and Kt/R) and Kt] on long-term survival of a cohort of 328 incident white HD patients. All individuals underwent periodical (every 3 months) biochemical evaluations and single-frequency BIA measurements, injecting 800 microA at 50 kHz alternating sinusoidal current with a standard tetrapolar technique. RESULTS: A first Cox regression analysis, testing the predictive power of some demographic, anthropometric, BIA and biochemical parameters, and of the eight HD adequacy indices on long-term survival of the patients, showed that only higher serum creatinine (Scr) levels (P < 0.0001) and lower Kt/R values (P < 0.04) were significant outcome predictors. As Kt was shown not to be an outcome predictor, a second Cox regression analysis, testing the predictive power of the same demographic, anthropometric, BIA and biochemical parameters, and of the seven scaling parameters on long-term survival of the patients, was built. It showed that only higher Scr levels (P < 0.0001) and higher R values (P < 0.04) were significant outcome predictors. Kaplan-Meier survival analyses of the patients stratified into two groups, respectively, according to the first quartile of R values (0.0-467.8 Ohm), the fourth quartile of Kt/R values (98-106 ml/Ohm) and the first quartile of Scr levels (0.0-11.6 mg/dl) showed a significantly higher long-term survival in the groups of patients having R values above the first quartile (P < 0.04), Kt/R values below the fourth quartile (P < 0.03) and Scr levels above the first quartile (P < 0.0001). CONCLUSIONS: Kt/R, R and Scr were independent significant predictors of long-term-survival in incident HD patients: R is related to the fluid status, whereas Scr, which reflects the lean body mass, seems to suggest that body composition is more important than body weight and/or body mass index. Further work is required to develop these concepts and to translate them into rigorous outcome-based adequacy targets suitable for clinical usage. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/20007130/Comparison_of_alternative_methods_for_scaling_dialysis_dose_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfp603 DB - PRIME DP - Unbound Medicine ER -