Ionic dialysance: a new valid parameter for quantification of dialysis efficiency in acute renal failure?
OBJECTIVE
Several studies have reported a close relationship between an increased dose of dialysis and survival in patients treated for acute renal failure. Unfortunately, the quantification of dialysis in critically ill patients based on the urea nitrogen formula Kt/V is not applicable. Ionic dialysance is a new parameter calculated in real time from the dialysate conductivity and correlated with the effective urea clearance in chronic hemodialysis patients. The aim of our study was to evaluate ionic dialysance in the quantification of dialysis in critically ill patients with acute renal failure.


METHODS
Prospective open-label study.


METHODS
An 18-bed medical intensive care unit.


METHODS
Thirty-one patients with multiple organ dysfunction syndrome and acute renal failure requiring intermittent hemodialysis were included.


METHODS
Using the first dialysis session of each patient, we compared the delivered dose of dialysis based on ionic dialysance measurement (Kt(ID)) with the well-accepted gold standard method based on fractional dialysate sampling (Kt(dialysate)). The data were analyzed using linear regression and Bland-Altman analysis.


RESULTS
Thirty-one intermittent hemodialysis sessions were performed in 31 critically ill patients (mean age 58+/-12 years, SAPS II score 56+/-10). We found a close correlation between Kt(dialysate) and Kt(ID) (Kt(dialysate) = 36.3+/-11.4 l; Kt(ID)=38.4+/-11.8; r=0.96) with excellent limits of agreement (-2.2 l; 6.4 l).


CONCLUSIONS
The feasibility of dialysis quantification based on ionic dialysance in the critically ill patient is good. This method is a simple and accurate tool for the determination of dialysis dose in critically ill patients.
Ridel
Christophe
C
Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Le Kremlin-Bicêtre, Paris, France. christophe.ridel@tnn.aphp.fr
Osman
David
D
Mercadal
Lucile
L
Anguel
Nadia
N
Petitclerc
Thierry
T
Richard
Christian
C
Vinsonneau
Christophe
C
D058186:Acute Kidney Injury / Q000378:metabolism / Q000628:therapy*; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000032:analysis*; D005260:Female; D006801:Humans; D007477:Ions; D016014:Linear Models; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000378:metabolism / Q000628:therapy; D009862:Online Systems; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D013813:Therapy, Computer-Assisted; D014508:Urea / Q000032:analysis*
D015314:Dialysis Solutions; D007477:Ions; D014508:Urea