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Nephrol Dial Transplant (1999) 14: 2407-2412
© 1999 European Renal Association-European Dialysis and Transplant Association

Improved clearance of iohexol with longer haemodialysis despite similar Kt/V for urea

Eva Johnsson2, Per-Ola Attman1, Ola Samuelsson1 and Börje Haraldsson1

1 Departments of Nephrology and 2 Clinical Pharmacology, Sahlgrenska University Hospital, Göteborg, Sweden

Correspondence and offprint requests to: Börje Haraldsson MD PhD, Department of Nephrology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

Background. The efforts to improve the quality of haemodialysis (HD) has renewed the interest in the consequences of blood-flow distribution for removal of solutes.

Methods. To test the effects of HD time per se, 10 patients were studied in a cross-over fashion with HD for 3 h and 1 week later for 6 h, with similar blood urea Kt/Vs, achieved by adjusting the blood flow rate to 290 and 120 ml/min respectively. Injections of iohexol (MW 821 Dalton) were given 2 days prior to the dialysis sessions. Blood samples were taken before, during (6/HD), 1 and 24 h after the HD and analysed for concentrations of urea and iohexol. A urea on-line monitor (Gambro) was used for continuous recordings and sampling of dialysate.

Results. According to the study design the blood Kt/V for urea (Daugirdas II) was similar for 3 and 6 h HD, close to 1.0 (n.s), while the removed mass of urea showed that Kt/V was slightly and significantly higher for the 6 h HD. The `apparent' mass of iohexol, defined as plasma concentration times estimated distribution volume, fell to 29% and 21% of pre-dialysis levels after 3 h and 6 h HD, respectively (P<0.01), but increased after HD, and more so after the short dialysis, reaching 46% of the predialysis mass 24 h after 3 h HD vs 36% after 6 h HD (P<0.05). The removed mass of iohexol was 920±110 mg with 6h HD and 700±81 mg with 3h HD, (P<0.01). Thus, the longer dialysis removed 32% more iohexol despite similar blood Kt/V for urea.

Conclusion. The treatment time per se affects solute removal despite similar blood Kt/V for urea. This is particularly true for an intermediate-size molecule like iohexol.

Keywords: adequacy; distribution; haemodialysis; iohexol; time; urea kinetics


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