Does provision of a higher Kt/V urea make a difference? A hemodialysis controversial issue.
BACKGROUND
Adequate dialysis cannot be ascertained on the sole base of a normal or even a high Kt/V(urea) so the impetus of this study was to use the neurophysiologic studies as a marker of the biologic status of the hemodialysis patients to assess the optimum level of Kt/V(urea).


METHODS
This study was carried out on 20 patients (15 men and 5 women) on maintenance hemodialysis; their ages ranged from 18 to 66 years. Initially, the patients were subjected to thorough clinical and laboratory investigations, and their dialysis adequacy was assessed by studying their urea kinetic modeling and neurophysiologic studies (Phase I). Dialysis was optimized to achieve a target Kt/V(urea) of 1.3 in Phase II and 1.5 in Phase III. The duration of each phase was six months at the end of which all patients were thoroughly reevaluated. Nutrition was not manipulated during the study.


RESULTS
A neurophysiologic study showed a significant improvement of polyphasicity pattern of both proximal and distal muscles of the upper and lower limbs concomitant with improvement of quality of life on achieving a Kt/V(urea) of 1.5 (p < 0.001). There was no significant change of the duration and amplitude of all studied muscles, however.


CONCLUSIONS
Achieving a Kt/V(urea) of 1.5 is a more suitable target for hemodialysis patients because it may be an avenue for improving the neuromuscular functions of these patients.
Abbas
Tarek M
TM
Department of Nephrology,Urology & Nephrology Center, and Department of Neurology, Mansoura University, Mansoura, Egypt.
Sheashaa
Hussein A
HA
Saad
Mohamed A
MA
Sobh
Mohamed A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009468:Neuromuscular Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards*; D014508:Urea / Q000493:pharmacokinetics*
D014508:Urea