Adjustment of hemodialysis dose for residual renal urea clearance: a two year study of impact on dialysis time.

Autor: Khan MS, Atav AS, Ishler MJ, Rehman Au, Lozano JE, Sklar AH
Jazyk: angličtina
Zdroj: ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2002 Jul-Aug; Vol. 48 (4), pp. 374-8.
DOI: 10.1097/00002480-200207000-00008
Abstrakt: Urea kinetic modeling suggests that significant time reductions may be realized in hemodialysis patients with residual renal urea clearance (K(r)t/V urea). However, the actual impact of a strategy that integrates such function into the dialysis prescription is not clear, because of both uncertainty regarding the rate of decay of K(r)t/V urea, as well as potential clinical constraints upon dose reduction. To examine this issue, we retrospectively reviewed data from 51 patients with K(r)t/N urea after initiation of maintenance hemodialysis. In 31 cases, there were no clinical barriers to adjustment of the dialysis prescriptions. Regression analysis revealed that each 0.10 increment in K(r)t/V urea yielded an actual dialysis time reduction of 12 minutes per week with average cumulative reduction of 80 minutes per week per patient. At approximately 1 year after initiation of dialysis, there were still 10 patients whose dialysis prescriptions were being adjusted on the basis of K(r)t/V urea. In conclusion, our results suggest that the incorporation of K(r)t/V urea in the hemodialysis prescription allows for substantial and enduring reductions in dialysis time in a significant minority of patients. Larger prospective studies are needed to evaluate the long-term safety of this strategy in modifying the dose of hemodialysis.
Databáze: MEDLINE