Nephrology Dialysis Transplantation, Vol 14, Issue 1 147-153, Copyright © 1999 by Oxford University Press
M Kuhlmann, K Konig, W Riegel and
Background: Inadequate dialysis dose is closely
related to mortality and morbidity of maintenance haemodialysis (MHD)
patients. According to the DOQI guidelines a minimum prescribed dialysis
dose of single-pool Kt/V (Kt/Vsp)=1.3, equivalent to equilibrated double
pool Kt/V (e-Kt/Vdp)=1.1, is recommended. Knowledge of patient-related risk
factors for inadequate delivery of haemodialysis would be helpful to select
patient subgroups for intensive control of dialysis adequacy.
Methods: A retrospective survey was conducted to
assess the prevalence of inadequate dialysis dose according to DOQI
criteria during a 7-month period. A total of 320 e-Kt/Vdp measurements in
62 MHD patients were evaluated (mean effective dialysis time
222±32 min). Residual renal function (RRF) was expressed as
renal weekly Kt/V (r-Kt/Vweek) and included into assessment of total weekly
renal and dialytic Kt/V (t-Kt/Vweek). Results:
Inadequacy (e-Kt/Vdp<1.10) was prevalent in 37.2% of all
measurements and in 22/62 patients (35.5%)). In 54% of underdialysed
patients r-Kt/Vweek compensated for insufficient dialytic urea removal.
Mean weekly Kt/V was inadequate (t-Kt/Vweek<3.30) in 12/62 patients
(19.4%) of whom 91.7% (11/12) were male. Body-weight, urea distribution
volume (UDV), and body-surface area (BSA) were significantly higher in
inadequately vs adequately dialysed males.
UDV>42.0 litres or BSA>2.0 m2 and a
lack of RRF (r-Kt/Vweek<0.3) put 'big men' at increased risk to
receive an inadequate dose of dialysis. Conclusions:
Our data identify patients at risk for inadequate haemodialysis treatment.
Special attention should be focused on 'big men' with UDV >42.0
litres or BSA >2.0 m2. In this subset of
patients frequent measurements of t-Kt/Vweek and assessment of RRF should
be mandatory. Key words: adequacy; DOQI guidelines;
haemodialysis; Kt/V; residual renal function; urea distribution volume
ORIGINAL ARTICLES
Gender-specific differences in dialysis quality (Kt/V): 'big men' are at risk of inadequate haemodialysis treatment
Innere Medizin IV, Nephrologie, Institut fur medizinische Biometrie, Epidemiologie und Medizinische Informatik, Universitat des Saarlandes, D-66421 Homburg/Saar, Germany; Corresponding author
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