A comparison of methods for determining urea distribution volume for routine use in on-line monitoring of haemodialysis adequacy.
BACKGROUND
The availability of haemodialysis machines equipped with on-line clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume 'V' is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods.


METHODS
Ten stable HD patients were monitored monthly for 6 months. Time-averaged OCM clearance (K(OCM)) and pre- and post-dialysis blood samples were collected at each monitored session. The second generation Daugirdas formula was used to calculate the single-pool variable volume Kt/V, (Kt/V)(D). Values of V to allow comparison between OCM and blood-based Kt/V were determined from Watson's formula (V(Watson)), bioimpedance spectroscopy (V(BIS)), classical urea kinetic modelling (V(UKM_C)) and a simple computation of V (V(UKM_S)) from the blood-based Kt/V and K(OCM)t.


RESULTS
Comparison of K(OCM)t/V with (Kt/V)(D) shows that using V(Watson) leads to significant systematic underestimation of dialysis dose. K(OCM)t/V(BIS) agrees with (Kt/V)(D) to within +/- 10%. K(OCM)t/V(UKM_S) is, by definition, identical to (Kt/V)(D) when initially calculated. However, if a historical value of V is used, agreement between K(OCM)t/V and (Kt/V)(D) over 6 months varies by 5% for V(BIS) and 10% for V(UKM_S).


CONCLUSIONS
When investigating the effect of different treatment strategies on dialysis efficiency, any estimate of V can be used provided it is constant, as K is the relevant parameter. When frequent supervision of actual dialysis dose is required, the greatest consistency between K(OCM)t/V and the reference, Kt/V(D), over time is achieved with V(BIS).
Lindley
Elizabeth J
EJ
Department of Renal Medicine, St James's University Hospital, Leeds, UK. Elizabeth.Lindley@leedsth.nhs.uk
Chamney
Paul W
PW
Wuepper
Andreas
A
Ingles
Helen
H
Tattersall
James E
JE
Will
Eric J
EJ
D000328:Adult; D005260:Female; D006801:Humans; D007688:Kidneys, Artificial / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods* / Q000706:statistics & numerical data; D009862:Online Systems; D006435:Renal Dialysis / Q000379:methods* / Q000706:statistics & numerical data; D014508:Urea / Q000378:metabolism*; D055815:Young Adult
D014508:Urea