Nephrology Dialysis Transplantation, Vol 12, Issue 9 1928-1933, Copyright © 1997 by Oxford University Press
F Maduell, J Garcia-Valdecasas, H Garcia, J Hdez-Jaras, F Siguenza, C del Pozo, R Giner, R Moll and E Garrigos
Background. The effect of increasing dialysis
efficiency magnifies rebound urea and the error in Kt/V determinations for
single pool urea kinetics. Several formulae have been developed to
calculate Kt/V taking into account the rebound urea (Kt/Vr). Smye
et al. proposed a method whereby the equilibrated BUN
is predicted by an additional intradialytic urea sample (Kt/VrSye).
Daugirdas et al. proposed a method where a single pool
Kt/V is modified according to the speed of dialysis to obtain a double pool
Kt/V (Kt/VrDaug). Maduell et al. developed a method
based on analysis of post-dialysis urea rebound whereby the Kt/Vr is
predicted according to the single pool Kt/V and K/V (Kt/VrMad).
Design of the study. We compared Kt/Vr estimated by
these three formulae (Smye, Daugirdas, and Maduell) in 384 patients
consisting of 211 males and 173 females, who received dialysis according to
their regular protocols. Plasma urea was measured at the beginning, 90-100
min following the start of dialysis, the end, and 45 min post-dialysis.
Results. Post-dialysis rebound urea was
22.4±9.7%. Kt/V and Kt/Vr obtained with rea kinetic model Kt/V
1.184±0.22 and 0.984±0.20, respectively. There was a
good correlation between Kt/Vr and the Smye formula
(Kt/VrSmye=0.956±021, r=0.729, P<0.001), and a better one
for Daugirdas (Kt/VrDaug=0.984±0.18, r=0.931, P<0.001),
and Maduell formulae (Kt/VrMad=0.980±0.18, r=0.946,
P<0.001). Limits of agreement and percentage of error estimated
according to Baland and Latman show that Kt/Vr estimated by Daugirdas and
Maduell formulae could be used in place of the Kt/Vr. The degree of
agreement with the Smye method is not clinically acceptable.
Conclusions. Our results suggest that the use of a
single pool Kt/V is not adequate to estimate the haemodialysis dose
delivered and Kt/Vr taking rebound urea in lysis dose delivered and Kt/V
taking rebound urea in consideration. Kt/Vr estimated by Daugirdas or
Maduell formulae are a simple and accurate method for use in clinical
practice. Keywords: Kt/V, kinetic urea; rebound urea
ORIGINAL ARTICLES
Validation of different methods to calculate Kt/V considering postdialysis rebound
Department of Nephrology, Hospital General de Castello, Hospital Clinico de Granada, Hospital de Gandia, Hospital de Xativa, Hospital de Alcoy, Hemogan, Hospital General de Valencia and Cedicas, Spain; Corresponding author at: Servicio de Nefrologia, Hospital General de Castellon, Av. Benicasim s/n, 12004 Castellon, Spain
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