title: Quantification of hemodialysis dose: what Kt/V  to choose?
abstract: BACKGROUND
  Quantification of hemodialysis became more accurate and easier after the advent of ionic dialysance and the use of methods for estimating urea distribution volume (V). The aim of this study was to compare different methods of hemodialysis dose assessment: Kt/VDau (Daugirdas 2nd generation), Kt/VOCM (Kt by OCM (Online Clearance Monitor) and V by Watson), and Kt/VBCM  (Kt by OCM and V by bio-impedance); and to assess the dialysis adequacy, defined by a Kt/V>1.4.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  35 hemodialysis sessions were evaluated in 35 chronic hemodialysis patients. During each session, we measured simultaneously, Kt/VOCM, Kt/VBCM and calculated Kt/VDau by performing blood samples before and after each session.
  
  
  RESULTS
  35 patients, gender (M/F: 19/16), mean age of 50.49 years, were evaluated. We noted a difference between the three methods of evaluating Kt/V index: Kt/VDau, Kt/VOCM and Kt/VBCM (1.82 ± 0.29; 1.45 ± 0.23; 1.8 ± 0.33, p<0.001). Comparison of Kt/VOCM with Kt/VDau and Kt/VBCM leads to a significant systematic underestimate of Kt/V by 22% and 20.5% respectively. Better agreement between Kt/VDau and Kt/VBCM was observed. The adequate hemodialysis was achieved, according to three methods:  Kt/VDau, Kt/VOCM and Kt/VBCM respectively in 100%, 57,1% and 88.6% of the cases.
  
  
  CONCLUSIONS
  The Kt/V index is different depending on the method used for its evaluation. The three methods can be used for quantification of hemodialysis with a better agreement between Kt/VDau and Kt/VBCM. In this study, Kt/VOCM results underestimate hemodialysis efficiency. This difference has to  be considered when applying quantification of hemodialysis to clinical practice.
authors.affiliation: Department of Nephrology, Dialysis and Renal Transplantation, Mohammed V Military Hospital, Faculty of Medicine, Mohammed V-Souissi University, Rabat - Morocco.
authors.forename: Taoufiq
authors.initials: T
authors.lastname: Aatif
authors.forename: Kawtar
authors.initials: K
authors.lastname: Hassani
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alayoud
authors.forename: Yassir
authors.initials: Y
authors.lastname: Zajjari
authors.forename: Omar
authors.initials: O
authors.lastname: Maoujoud
authors.forename: Mohamed
authors.initials: M
authors.lastname: Benyahia
authors.forename: Zouhair
authors.initials: Z
authors.lastname: Oualim
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000008:administration & dosage*; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D015314:Dialysis Solutions; D014508:Urea