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Karger Publishers, Blood Purification, 4(32), p. 271-277, 2011

DOI: 10.1159/000330340

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Determination of Dialysis Dose- A Clinical Comparison of Methods

Journal article published in 2011 by Hans-Georg Wullstein, Peter Ahrenholz, Petr Taborsky, Margot Bowling, Margot Bohling, Peter Rauer, Peter Rawer, Noureddin Ibrahim, Martin Gajdos, Petr Machek, Michaela Sagova, Hans Gruber, Gunter Tönne, Pavel Moucka, Jindnska Pössnerickerova and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

<i>Background:</i> Guidelines recommend regular measurements of the delivered hemodialysis dose Kt/V. Nowadays, automatic non-invasive online measurements are available as alternatives to the conventional method with blood sampling, laboratory analysis, and calculation. <i>Methods:</i>In a prospective clinical trial, three different methods determining dialysis dose were simultaneously applied: Kt/V<sub>Dau</sub> (conventional method with Daugirdas’ formula), Kt/V<sub>OCM</sub> [online clearance measurement (OCM) with urea distribution volume V based on anthropometric estimate], and Kt/V<sub>BCM</sub> [OCM measurement with V measured by bioimpedance analysis (Body Composition Monitor)]. <i>Results:</i>1,076 hemodialysis patients were analyzed. The dialysis dose was measured as Kt/V<sub>Dau</sub> = 1.74 ± 0.45, Kt/V<sub>OCM</sub> = 1.47 ± 0.34, and Kt/V<sub>BCM</sub> = 1.65 ± 0.42. The difference between Kt/V<sub>OCM</sub> and Kt/V<sub>BCM</sub> was due to the difference between anthropometric estimated V<sub>Watson</sub> and measured V<sub>BCM</sub>. Compared to Kt/V<sub>Dau</sub>, Kt/V<sub>OCM</sub> was 15% lower and Kt/V<sub>BCM</sub> 5% lower. Kt/V<sub>Dau</sub> was incidentally prone to falsely high values due to operative errors, whereas in these cases OCM-based measurements Kt/V<sub>OCM</sub> and Kt/V<sub>BCM</sub> delivered realistic values. <i>Conclusions:</i>The automated OCM Kt/V<sub>OCM</sub> with anthropometric estimation of urea distribution volume was the easiest method to use, but Kt/V<sub>BCM</sub> with measured urea distribution volume was closer to the conventional method.