Evaluating a new method to judge dialysis treatment using online measurements of ionic clearance.
New technology now supports direct online measurements of total dialysis dose per treatment, Kt. An outcome-based, nonlinear method for estimating target Kt in terms of ionic clearance measurements and body surface area (BSA) has been described recently. This is a validation study of the new method that evaluates the relationship between the (actual Kt-target Kt) difference and death risk. Patients with Kt measurements during March 2004 were identified (N=59,644). Target Kt was determined for each patient using the new method. Patients were then grouped by (actual Kt-target Kt) decile. They were also grouped by (actual URR-target URR) decile. Cox analysis-based risk profiles were constructed using those groupings. The (actual Kt-target Kt) difference profiles suggested improving death risk as Kt increased from below target to equal target. Risk ratios then flattened and remained so until (actual Kt-target Kt) reached the highest decile at which it appeared to improve, suggesting a possible biphasic profile. The (URR-target URR) risk profile was U-shaped. Death risk was related to the difference between the actual Kt and a target Kt value selected using the new nonlinear method. The method is therefore valid for prescribing and monitoring hemodialysis treatment.
Lowrie
E G
EG
Fresenius Medical Care North America, Lexington, Massachusetts, USA. dlowrie@prodigy.net
Li
Z
Z
Ofsthun
N J
NJ
Lazarus
J M
JM
D001830:Body Surface Area; D005260:Female; D006801:Humans; D007477:Ions / Q000032:analysis; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009862:Online Systems; D011379:Prognosis; D006435:Renal Dialysis / Q000592:standards*; D012306:Risk; D014508:Urea / Q000032:analysis
D007477:Ions; D014508:Urea