NDT Advance Access originally published online on November 27, 2008
Nephrology Dialysis Transplantation 2009 24(4):1267-1274; doi:10.1093/ndt/gfn641
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Assessment of urea removal in haemodialysis and the impact of the European Best Practice Guidelines
1 French ESRD Registry REIN, Agence de la biomedecine, Saint-Denis La Plaine, France 2 Department of Medical Informatics, ERA–EDTA Registry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 3 UK Renal Registry, Bristol, UK 4 REIN registry in Bourgogne, Châlon sur Saône, France 5 French-Speaking Belgium Renal Registry, Bruxelles, Belgium 6 Finnish Registry for Kidney Disease, Helsinki, Finland 7 Spanish Society of Nephrology, Santander, Spain 8 REIN registry in Lorraine, Vanedoeuvre-les-Nancy, France 9 Romanian Renal Registry, Bucarest, Romania 10 Norway Renal Registry, Oslo, Norway 11 REIN registry in Nord-Pas de Calais, Valenciennes, France 12 Italian Renal Registry, Gallarate, Italy 13 Estonian Renal Registry, Tartu, Estonia 14 Bosnia Herzegovina Renal Registry, Sarajevo, Bosnia Herzegovina 15 Macedonian Renal Registry, Skopje, FYR of Macedonia 16 University hospital of Maastricht, Maastricht, The Netherlands
Correspondence and offprint requests to: Cécile Couchoud, Coordination nationale de Rein, Agence de la biomédecine, 1 avenue du Stade de France, 93212 Saint Denis La Plaine Cedex, France. Tel: +33-1-55-93-64-67; Fax: +33-1-55-93-69-36; E-mail: cecile.couchoud{at}biomedecine.fr
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Abstract |
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Background. Dialysis adequacy, assessed by urea kinetics, is an important determinant of patient outcome, and is therefore an important clinical performance indicator. In this perspective, renal registry data may be useful to compare practices across countries. To serve that purpose available data should be comparable and preferably collected using a standardized procedure. The aim of this study, initiated by the European Renal Association–European Dialysis and Transplantation Association (ERA–EDTA) QUality European STudies (QUEST) initiative, was to make an inventory of the different methods used to determine urea kinetic measurements in the light of the European Best Practice Guidelines.
Methods. Via their national and regional registries, European haemodialysis centres were invited to complete a questionnaire regarding their practice of measuring dialysis adequacy.
Results. Fourteen regional or national registries among 51 sent back 255 questionnaires. Great variability in the methodology to assess Kt/V was observed. The urea reduction ratio (URR) was used alone by 37% (in association 46%) of dialysis centres, spKt/V by 25% (35%) and on-line clearance by 4% (12%), whereas only 10% (13%) used eKt/V, as recommended by EBPG. Forty percent of centres measured urea removal less than once a month, 6% of which never measured urea removal and 9% only every 6 months or less frequently.
Conclusion. Despite the fact that the use of URR is not recommended by EBPG, it was the most commonly used indicator to measure urea removal, whereas eKt/V was only used by a small minority of centres. This study allowed us to point out the need to standardize definitions and procedures and to develop an effective plan for implementation of the guidelines.
Keywords: best practice guidelines; dialysis adequacy; ESRD registry; Kt/V; urea removal
Received for publication: 3. 9.08
Accepted in revised form: 23.10.08