Adjustment of hemodialysis dose for residual renal urea clearance: a two year study of impact on dialysis time.
Urea kinetic modeling suggests that significant time reductions may be realized in hemodialysis patients with residual renal urea clearance (K(r)t/V urea). However, the actual impact of a strategy that integrates such function into the dialysis prescription is not clear, because of both uncertainty regarding the rate of decay of K(r)t/V urea, as well as potential clinical constraints upon dose reduction. To examine this issue, we retrospectively reviewed data from 51 patients with K(r)t/N urea after initiation of maintenance hemodialysis. In 31 cases, there were no clinical barriers to adjustment of the dialysis prescriptions. Regression analysis revealed that each 0.10 increment in K(r)t/V urea yielded an actual dialysis time reduction of 12 minutes per week with average cumulative reduction of 80 minutes per week per patient. At approximately 1 year after initiation of dialysis, there were still 10 patients whose dialysis prescriptions were being adjusted on the basis of K(r)t/V urea. In conclusion, our results suggest that the incorporation of K(r)t/V urea in the hemodialysis prescription allows for substantial and enduring reductions in dialysis time in a significant minority of patients. Larger prospective studies are needed to evaluate the long-term safety of this strategy in modifying the dose of hemodialysis.
Mahmud S
MS
Khan
A Serdar
AS
Atav
Melissa J
MJ
Ishler
Afzal ur
Au
Rehman
Jose E
JE
Lozano
Allan H
AH
Sklar
D006801:Humans; D007668:Kidney / Q000378:metabolism*; D008657:Metabolic Clearance Rate; D006435:Renal Dialysis; D013997:Time Factors; D014508:Urea / Q000378:metabolism*
D014508:Urea