title: Which comes first, Kt/V or PCR--chicken or egg?
abstract: We previously hypothesized that PCR is dependent on Kt/V (urea). To test the hypothesis, 30 patients from two hemodialysis (HD) units with PCR values consistently less than 1 regardless of the Kt/V (urea) without an obvious cause (such as malignancy, peptic ulceration, etc.) were identified. These patients were randomized into an experimental group where an increase in the Kt/V (urea) was made or into a control group where a Kt/V (urea) remained unchanged. In the experimental group the minimal increment in Kt/V (urea) was 0.3 plus a minimum requirement of a Kt/V (urea) greater than or equal to 1. The control group were to maintain the existing Kt/V (urea) within +/- 0.2. Urea kinetic modeling was monitored monthly and the patients followed for three months. Of 30 patients, 18 fulfilled the criteria (9 experimental; 9 controls). In the experimental group, the initial Kt/V (urea) was 0.82 +/- 0.19 (means +/- SD); the final Kt/V (urea) was 1.32 +/- 0.21 (P = 0.000). These patients had an initial PCR of 0.81 +/- 0.08. This increased to 1.02 +/- 0.15 (P = 0.005). The control group had an initial Kt/V (urea) of 0.82 +/- 0.16. The final Kt/V (urea) was 0.87 +/- 0.15. Their initial PCR was 0.87 +/- 0.14 and the final PCR was 0.86 +/- 0.087 (P = NS). In the experimental group, the mean increments in Kt/V (urea) and PCR were 0.49 +/- 0.17 and 0.21 +/- 0.16 (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Artificial Kidney Research Centre, Victoria Hospital, London, Ontario, Canada.
authors.forename: R M
authors.initials: RM
authors.lastname: Lindsay
authors.forename: E
authors.initials: E
authors.lastname: Spanner
authors.forename: R P
authors.initials: RP
authors.lastname: Heidenheim
authors.forename: J M
authors.initials: JM
authors.lastname: LeFebvre
authors.forename: A
authors.initials: A
authors.lastname: Hodsman
authors.forename: J
authors.initials: J
authors.lastname: Baird
authors.forename: M E
authors.initials: ME
authors.lastname: Allison
mesh_terms: D006801:Humans; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011446:Prospective Studies; D011506:Proteins / Q000378:metabolism*; D006435:Renal Dialysis; D014508:Urea / Q000378:metabolism*
chemical_list: D011506:Proteins; D014508:Urea