title: Online conductivity monitoring of dialysis adequacy versus Kt/V derived from urea reduction ratio: a prospective study from a Saudi Center.
abstract: BACKGROUND
  Adequate delivered dose of solute removal (as assessed by urea reduction and calculation of Kt/V) is an important determinant of clinical outcome in chronic hemodialysis (HD) patients. This requires both prescription of an adequate dose of HD and regular assessment that the delivered treatments are also adequate. Online conductivity monitoring (OCM) using sodium flux as a surrogate for urea allows for the repeated non-invasive measurement of Kt/V on each HD treatment.
  
  
  METHODS
  We prospectively studied 17 (9 males, 8 females) established chronic HD patients over an eight-week period (408 treatments). A pre- and post-dialyzer measurement of the conductivity is performed by two mutually independent temperature-compensated conductivity cells equipped with Fresenius 4008 S(R) dialysis machines. Urea reduction was measured once a week by a single-pool calculation using immediate post-treatment sampling. No changes were made to any of the dialysis prescriptions over the study period. Values of calculated Kt/V and simultaneously obtained online Kt/V were compared.
  
  
  RESULTS
  There was a statistically significant difference between calculated Kt/V and online Kt/V over the study period. The mean calculated Kt/V was 1.37 +/- 0.09, and mean online Kt/V 1.02 +/- 0.15 (p = 0.000). Calculated Kt/V >or= 1.2 was achieved in all our patients, while online Kt/V >or= 1.2 was achieved in only 17.64%. Yet there was moderate correlation between calculated Kt/V and online Kt/V (r(2) = 0.48).
  
  
  CONCLUSIONS
  Online conductivity monitoring (OCM) results underestimates dialysis efficiency compared to calculated Kt/V readings. This difference has to be considered when applying Kt/V to clinical practice.
authors.affiliation: Prince Salman Center for Kidney Disease, Riyadh, Kingdom of Saudi Arabia. Khalid_aln@yahoo.co.uk
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Saran
authors.forename: Alaa
authors.initials: A
authors.lastname: Sabry
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Abdulghafour
authors.forename: Ahmed
authors.initials: A
authors.lastname: Yehia
mesh_terms: D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D006435:Renal Dialysis / Q000592:standards*; D012529:Saudi Arabia; D014508:Urea / Q000378:metabolism*
chemical_list: D015312:Hemodialysis Solutions; D014508:Urea