title: Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study.
abstract: The Hemodialysis (HEMO) Study showed that high-dose hemodialysis providing a single-pool Kt/Vureaof 1.71 provided no benefit over a standard treatment providing a single-pool Kt/Vureaof 1.32. Here, we assessed whether the high-dose treatment used lowered plasma levels of small uremic solutes other than urea. Measurements made ≥3 months after randomization in 1281 patients in the HEMO Study showed a range in the effect of high-dose treatment compared with that of standard treatment: from no reduction in the level of p-cresol sulfate or asymmetric dimethylarginine to significant reductions in the levels of trimethylamine oxide (-9%; 95% confidence interval [95% CI], -2% to -15%), indoxyl sulfate (-11%; 95% CI, -6% to -15%), and methylguanidine (-22%; 95% CI, -18% to -27%). Levels of three other small solutes also decreased slightly; the level of urea decreased 9%. All-cause mortality did not significantly relate to the level of any of the solutes measured. Modeling indicated that the intermittency of treatment along with the presence of nondialytic clearance and/or increased solute production accounted for the limited reduction in solute levels with the higher Kt/VureaIn conclusion, failure to achieve greater reductions in solute levels may explain the failure of high Kt/Vureatreatment to improve outcomes in the HEMO Study. Furthermore, levels of the nonurea solutes varied widely among patients in the HEMO Study, and achieved Kt/Vureaaccounted for very little of this variation. These results further suggest that an index only on the basis of urea does not provide a sufficient measure of dialysis adequacy.
authors.affiliation: Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California; twmeyer@stanford.edu.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Meyer
authors.affiliation: Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California.
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Sirich
authors.affiliation: Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California.
authors.forename: Kara D
authors.initials: KD
authors.lastname: Fong
authors.affiliation: Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California.
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Plummer
authors.affiliation: Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Tariq
authors.initials: T
authors.lastname: Shafi
authors.affiliation: Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Seungyoung
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Medicine, University of California, San Francisco, California; and.
authors.forename: Tanushree
authors.initials: T
authors.lastname: Banerjee
authors.affiliation: Department of Medicine, University of California, San Francisco, California; and.
authors.forename: Yunnuo
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Medicine, University of California, San Francisco, California; and.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Xin
authors.initials: X
authors.lastname: Hai
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Hostetter
mesh_terms: D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014508:Urea / Q000032:analysis / Q000378:metabolism*
chemical_list: D015312:Hemodialysis Solutions; D014508:Urea
keywords: hemodialysis; hemodialysis adequacy; uremia