Half the V by 120: A practical approach to the prevention of the dialysis disequilibrium syndrome.

Autor: Genena KH; Nephrology Division, Baylor University Medical Center, Dallas, Texas, USA., Ahmed S; Dallas Nephrology Associates, Dallas, Texas, USA., Szerlip HM; Nephrology Division, Baylor University Medical Center, Dallas, Texas, USA., Schwartz JC; Dallas Nephrology Associates, Dallas, Texas, USA.
Jazyk: angličtina
Zdroj: Hemodialysis international. International Symposium on Home Hemodialysis [Hemodial Int] 2021 Oct; Vol. 25 (4), pp. 424-432. Date of Electronic Publication: 2021 Jun 18.
DOI: 10.1111/hdi.12938
Abstrakt: The dialysis disequilibrium syndrome (DDS) results from osmotic shifts between the blood and the brain compartments. Patients at risk for DDS include those with very elevated blood urea nitrogen, concomitant hypernatremia, metabolic acidosis, and low total body water volumes. By understanding the underlying pathophysiology and applying urea kinetic modeling, it is possible to avoid the occurrence of this disorder. A urea reduction ratio (URR) of no more than 40%-45% over 2 h is recommended for the initial hemodialysis treatment. The relationship between the URR and Kt/V is useful when trying to model the dialysis treatment to a specific URR target. A simplified relationship between Kt/V and URR is provided by the equation: Kt/V = -ln (1 - URR). A URR of 40% is roughly equivalent to a Kt/V of 0.5. The required dialyzer urea clearance to achieve this goal URR in a 120-min treatment can simply be calculated by dividing half the patient's volume of distribution of urea by 120. The blood flow rate and dialyzer mass transfer coefficient (K 0 A) required to achieve this clearance can then be plotted on a nomogram. Other methods to reduce the risk of DDS are reviewed, including the use of continuous renal replacement therapy.
(© 2021 International Society for Hemodialysis.)
Databáze: MEDLINE
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