Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure
Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure. Prospective, formal, blood-side, urea kinetic modeling (UKM) has yet to be applied in intermittent hemodialysis for acute renal failure (ARF). Methods for prescribing a target, equilibrated Kt/V (e...
Gespeichert in:
| Veröffentlicht in: | Kidney international 2003-12, Vol.64 (6), p.2298-2310 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2310 |
|---|---|
| container_issue | 6 |
| container_start_page | 2298 |
| container_title | Kidney international |
| container_volume | 64 |
| creator | Kanagasundaram, Nigel S. Greene, T.O.M. Larive, A. Brett Daugirdas, John T. Depner, Thomas A. Garcia, Michelle Paganini, Emil P. on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group |
| description | Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure.
Prospective, formal, blood-side, urea kinetic modeling (UKM) has yet to be applied in intermittent hemodialysis for acute renal failure (ARF). Methods for prescribing a target, equilibrated Kt/V (eKt/V) are described for this setting.
Serial sessions (N = 108) were studied in 28 intensive care unit ARF patients. eKt/V was derived using delayed posthemodialyis urea samples and formal, double-pool UKM (eKt/Vref), and by applying the Daugirdas-Schneditz venous rate equation to pre- and posthemodialysis samples (eKt/Vrate). Individual components of prescribed and delivered dose were compared. Prescribed eKt/V values were determined using in vivo dialyzer clearance estimates and anthropometric (Watson and adjusted Chertow) and modeled urea volumes.
eKt/Vref (mean ± SD = 0.91 ± 0.26) was well-approximated by eKt/Vrate (0.92 ± 0.25), R = 0.92. Modeled V exceeded Watson V by 25% ± 29% (P < 0.001) and Adjusted Chertow V by 18%± 28% (P < 0.001), although the degree of overestimation diminished over time. This difference was influenced by access recirculation (AR) and use of saline flushes. The median % difference between Vdprate and Watson V was reduced to 1% after adjusting for AR for the 22 sessions with ≤1 saline flush. The median coefficients of variation for serial determinations of Adjusted Chertow V, modeled V, urea generation rate, and eKt/Vref were 2.7%, 12.2%, 30.1%, and 16.4%, respectively. Because of comparatively higher modeled urea Vs, delivered eKt/Vref was lower than prescribed eKt/V, based on Watson V or Adjusted Chertow V, by 0.13 and 0.08 Kt/V units. The median absolute errors of prescribed eKt/V vs. delivered therapy (eKt/Vref) were not large and were similar in prescriptions based on the Adjusted Chertow V (0.127) vs. those based on various double-pool modeled urea volumes (∼0.127).
Equilibrated Kt/V can be derived using formal, double-pool UKM in intensive care unit ARF patients, with the venous rate equation providing a practical alternative. A target eKt/V can be prescribed to within a median absolute error of less than 0.14 Kt/V units using practical prescription algorithms. The causes of the increased apparent volume of urea distribution appear to be multifactorial and deserve further investigation. |
| doi_str_mv | 10.1046/j.1523-1755.2003.00337.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71397452</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0085253815496012</els_id><sourcerecordid>1012073791</sourcerecordid><originalsourceid>FETCH-LOGICAL-c477t-38dfccdf463089e1dc3af175973dad38aa4cc6c2600eac20e62350f9d438d0893</originalsourceid><addsrcrecordid>eNqFkUFr3DAQhUVoSTbb_IUiCu3NrmRZtvfYhjQJBNpDexaz0jidxZYTSQ7Jv6-cXRrIJQcxiPlmeO8NY1yKUoq6-borpa5UIVuty0oIVean2vLxiK3-N96xlRCdLiqtuhN2GuNO5P9GiWN2IutGKan1iuGvgNEG2pK_5eA53s800DZAQsfJJwwjpYQ-8b84To5geIoUuZsi5vYz4SM9ILcQkM-eEgc7J-QBPQy8BxrmgB_Y-x6GiGeHumZ_flz8Pr8qbn5eXp9_uyls3bapUJ3rrXV9VpeVonRWQZ-9bFrlwKkOoLa2sVUjBIKtBDaV0qLfuDpPLt7W7Mt-712Y7meMyYwULQ4DeJzmaFqpNm2dE1qzT6_A3TSHrDiaSgqplNAqQ90esmGKMWBv7gKNEJ6MFGa5g9mZJW6zxG2WO5jnO5jHPPrxsH_ejuheBg_BZ-DzAYBoYegDeEvxhdNV13VycfR9z2GO7YEwmGgJvUVHAW0ybqK31fwD7mqn1A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>210133053</pqid></control><display><type>article</type><title>Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>ProQuest Central UK/Ireland</source><source>Alma/SFX Local Collection</source><creator>Kanagasundaram, Nigel S. ; Greene, T.O.M. ; Larive, A. Brett ; Daugirdas, John T. ; Depner, Thomas A. ; Garcia, Michelle ; Paganini, Emil P. ; on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creator><creatorcontrib>Kanagasundaram, Nigel S. ; Greene, T.O.M. ; Larive, A. Brett ; Daugirdas, John T. ; Depner, Thomas A. ; Garcia, Michelle ; Paganini, Emil P. ; on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group ; Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group ; on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creatorcontrib><description>Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure.
Prospective, formal, blood-side, urea kinetic modeling (UKM) has yet to be applied in intermittent hemodialysis for acute renal failure (ARF). Methods for prescribing a target, equilibrated Kt/V (eKt/V) are described for this setting.
Serial sessions (N = 108) were studied in 28 intensive care unit ARF patients. eKt/V was derived using delayed posthemodialyis urea samples and formal, double-pool UKM (eKt/Vref), and by applying the Daugirdas-Schneditz venous rate equation to pre- and posthemodialysis samples (eKt/Vrate). Individual components of prescribed and delivered dose were compared. Prescribed eKt/V values were determined using in vivo dialyzer clearance estimates and anthropometric (Watson and adjusted Chertow) and modeled urea volumes.
eKt/Vref (mean ± SD = 0.91 ± 0.26) was well-approximated by eKt/Vrate (0.92 ± 0.25), R = 0.92. Modeled V exceeded Watson V by 25% ± 29% (P < 0.001) and Adjusted Chertow V by 18%± 28% (P < 0.001), although the degree of overestimation diminished over time. This difference was influenced by access recirculation (AR) and use of saline flushes. The median % difference between Vdprate and Watson V was reduced to 1% after adjusting for AR for the 22 sessions with ≤1 saline flush. The median coefficients of variation for serial determinations of Adjusted Chertow V, modeled V, urea generation rate, and eKt/Vref were 2.7%, 12.2%, 30.1%, and 16.4%, respectively. Because of comparatively higher modeled urea Vs, delivered eKt/Vref was lower than prescribed eKt/V, based on Watson V or Adjusted Chertow V, by 0.13 and 0.08 Kt/V units. The median absolute errors of prescribed eKt/V vs. delivered therapy (eKt/Vref) were not large and were similar in prescriptions based on the Adjusted Chertow V (0.127) vs. those based on various double-pool modeled urea volumes (∼0.127).
Equilibrated Kt/V can be derived using formal, double-pool UKM in intensive care unit ARF patients, with the venous rate equation providing a practical alternative. A target eKt/V can be prescribed to within a median absolute error of less than 0.14 Kt/V units using practical prescription algorithms. The causes of the increased apparent volume of urea distribution appear to be multifactorial and deserve further investigation.</description><identifier>ISSN: 0085-2538</identifier><identifier>EISSN: 1523-1755</identifier><identifier>DOI: 10.1046/j.1523-1755.2003.00337.x</identifier><identifier>PMID: 14633155</identifier><identifier>CODEN: KDYIA5</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Acute Kidney Injury - therapy ; Adult ; Algorithms ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood Urea Nitrogen ; body water ; dialysis dose ; diffusion ; disequilibrium ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Humans ; Intensive care medicine ; Intensive Care Units ; Kinetics ; Male ; Medical sciences ; Models, Biological ; Prescriptions ; protein catabolic rate ; Renal Dialysis ; urea ; Urea - blood ; urea distribution volume ; urea generation ; urea kinetic modeling ; urea rebound</subject><ispartof>Kidney international, 2003-12, Vol.64 (6), p.2298-2310</ispartof><rights>2003 International Society of Nephrology</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Dec 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-38dfccdf463089e1dc3af175973dad38aa4cc6c2600eac20e62350f9d438d0893</citedby><cites>FETCH-LOGICAL-c477t-38dfccdf463089e1dc3af175973dad38aa4cc6c2600eac20e62350f9d438d0893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/210133053?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,64361,64363,64365,72215</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15288819$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14633155$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kanagasundaram, Nigel S.</creatorcontrib><creatorcontrib>Greene, T.O.M.</creatorcontrib><creatorcontrib>Larive, A. Brett</creatorcontrib><creatorcontrib>Daugirdas, John T.</creatorcontrib><creatorcontrib>Depner, Thomas A.</creatorcontrib><creatorcontrib>Garcia, Michelle</creatorcontrib><creatorcontrib>Paganini, Emil P.</creatorcontrib><creatorcontrib>on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creatorcontrib><creatorcontrib>Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creatorcontrib><creatorcontrib>on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creatorcontrib><title>Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure</title><title>Kidney international</title><addtitle>Kidney Int</addtitle><description>Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure.
Prospective, formal, blood-side, urea kinetic modeling (UKM) has yet to be applied in intermittent hemodialysis for acute renal failure (ARF). Methods for prescribing a target, equilibrated Kt/V (eKt/V) are described for this setting.
Serial sessions (N = 108) were studied in 28 intensive care unit ARF patients. eKt/V was derived using delayed posthemodialyis urea samples and formal, double-pool UKM (eKt/Vref), and by applying the Daugirdas-Schneditz venous rate equation to pre- and posthemodialysis samples (eKt/Vrate). Individual components of prescribed and delivered dose were compared. Prescribed eKt/V values were determined using in vivo dialyzer clearance estimates and anthropometric (Watson and adjusted Chertow) and modeled urea volumes.
eKt/Vref (mean ± SD = 0.91 ± 0.26) was well-approximated by eKt/Vrate (0.92 ± 0.25), R = 0.92. Modeled V exceeded Watson V by 25% ± 29% (P < 0.001) and Adjusted Chertow V by 18%± 28% (P < 0.001), although the degree of overestimation diminished over time. This difference was influenced by access recirculation (AR) and use of saline flushes. The median % difference between Vdprate and Watson V was reduced to 1% after adjusting for AR for the 22 sessions with ≤1 saline flush. The median coefficients of variation for serial determinations of Adjusted Chertow V, modeled V, urea generation rate, and eKt/Vref were 2.7%, 12.2%, 30.1%, and 16.4%, respectively. Because of comparatively higher modeled urea Vs, delivered eKt/Vref was lower than prescribed eKt/V, based on Watson V or Adjusted Chertow V, by 0.13 and 0.08 Kt/V units. The median absolute errors of prescribed eKt/V vs. delivered therapy (eKt/Vref) were not large and were similar in prescriptions based on the Adjusted Chertow V (0.127) vs. those based on various double-pool modeled urea volumes (∼0.127).
Equilibrated Kt/V can be derived using formal, double-pool UKM in intensive care unit ARF patients, with the venous rate equation providing a practical alternative. A target eKt/V can be prescribed to within a median absolute error of less than 0.14 Kt/V units using practical prescription algorithms. The causes of the increased apparent volume of urea distribution appear to be multifactorial and deserve further investigation.</description><subject>Acute Kidney Injury - therapy</subject><subject>Adult</subject><subject>Algorithms</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood Urea Nitrogen</subject><subject>body water</subject><subject>dialysis dose</subject><subject>diffusion</subject><subject>disequilibrium</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Kinetics</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Models, Biological</subject><subject>Prescriptions</subject><subject>protein catabolic rate</subject><subject>Renal Dialysis</subject><subject>urea</subject><subject>Urea - blood</subject><subject>urea distribution volume</subject><subject>urea generation</subject><subject>urea kinetic modeling</subject><subject>urea rebound</subject><issn>0085-2538</issn><issn>1523-1755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkUFr3DAQhUVoSTbb_IUiCu3NrmRZtvfYhjQJBNpDexaz0jidxZYTSQ7Jv6-cXRrIJQcxiPlmeO8NY1yKUoq6-borpa5UIVuty0oIVean2vLxiK3-N96xlRCdLiqtuhN2GuNO5P9GiWN2IutGKan1iuGvgNEG2pK_5eA53s800DZAQsfJJwwjpYQ-8b84To5geIoUuZsi5vYz4SM9ILcQkM-eEgc7J-QBPQy8BxrmgB_Y-x6GiGeHumZ_flz8Pr8qbn5eXp9_uyls3bapUJ3rrXV9VpeVonRWQZ-9bFrlwKkOoLa2sVUjBIKtBDaV0qLfuDpPLt7W7Mt-712Y7meMyYwULQ4DeJzmaFqpNm2dE1qzT6_A3TSHrDiaSgqplNAqQ90esmGKMWBv7gKNEJ6MFGa5g9mZJW6zxG2WO5jnO5jHPPrxsH_ejuheBg_BZ-DzAYBoYegDeEvxhdNV13VycfR9z2GO7YEwmGgJvUVHAW0ybqK31fwD7mqn1A</recordid><startdate>20031201</startdate><enddate>20031201</enddate><creator>Kanagasundaram, Nigel S.</creator><creator>Greene, T.O.M.</creator><creator>Larive, A. Brett</creator><creator>Daugirdas, John T.</creator><creator>Depner, Thomas A.</creator><creator>Garcia, Michelle</creator><creator>Paganini, Emil P.</creator><creator>on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creator><general>Elsevier Inc</general><general>Nature Publishing</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20031201</creationdate><title>Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure</title><author>Kanagasundaram, Nigel S. ; Greene, T.O.M. ; Larive, A. Brett ; Daugirdas, John T. ; Depner, Thomas A. ; Garcia, Michelle ; Paganini, Emil P. ; on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-38dfccdf463089e1dc3af175973dad38aa4cc6c2600eac20e62350f9d438d0893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Acute Kidney Injury - therapy</topic><topic>Adult</topic><topic>Algorithms</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Urea Nitrogen</topic><topic>body water</topic><topic>dialysis dose</topic><topic>diffusion</topic><topic>disequilibrium</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Kinetics</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Models, Biological</topic><topic>Prescriptions</topic><topic>protein catabolic rate</topic><topic>Renal Dialysis</topic><topic>urea</topic><topic>Urea - blood</topic><topic>urea distribution volume</topic><topic>urea generation</topic><topic>urea kinetic modeling</topic><topic>urea rebound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kanagasundaram, Nigel S.</creatorcontrib><creatorcontrib>Greene, T.O.M.</creatorcontrib><creatorcontrib>Larive, A. Brett</creatorcontrib><creatorcontrib>Daugirdas, John T.</creatorcontrib><creatorcontrib>Depner, Thomas A.</creatorcontrib><creatorcontrib>Garcia, Michelle</creatorcontrib><creatorcontrib>Paganini, Emil P.</creatorcontrib><creatorcontrib>on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creatorcontrib><creatorcontrib>Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creatorcontrib><creatorcontrib>on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Kidney international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kanagasundaram, Nigel S.</au><au>Greene, T.O.M.</au><au>Larive, A. Brett</au><au>Daugirdas, John T.</au><au>Depner, Thomas A.</au><au>Garcia, Michelle</au><au>Paganini, Emil P.</au><au>on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</au><aucorp>Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</aucorp><aucorp>on behalf of the Project for the Improvement of the Care of Acute Renal Dysfunction (PICARD) Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure</atitle><jtitle>Kidney international</jtitle><addtitle>Kidney Int</addtitle><date>2003-12-01</date><risdate>2003</risdate><volume>64</volume><issue>6</issue><spage>2298</spage><epage>2310</epage><pages>2298-2310</pages><issn>0085-2538</issn><eissn>1523-1755</eissn><coden>KDYIA5</coden><abstract>Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure.
Prospective, formal, blood-side, urea kinetic modeling (UKM) has yet to be applied in intermittent hemodialysis for acute renal failure (ARF). Methods for prescribing a target, equilibrated Kt/V (eKt/V) are described for this setting.
Serial sessions (N = 108) were studied in 28 intensive care unit ARF patients. eKt/V was derived using delayed posthemodialyis urea samples and formal, double-pool UKM (eKt/Vref), and by applying the Daugirdas-Schneditz venous rate equation to pre- and posthemodialysis samples (eKt/Vrate). Individual components of prescribed and delivered dose were compared. Prescribed eKt/V values were determined using in vivo dialyzer clearance estimates and anthropometric (Watson and adjusted Chertow) and modeled urea volumes.
eKt/Vref (mean ± SD = 0.91 ± 0.26) was well-approximated by eKt/Vrate (0.92 ± 0.25), R = 0.92. Modeled V exceeded Watson V by 25% ± 29% (P < 0.001) and Adjusted Chertow V by 18%± 28% (P < 0.001), although the degree of overestimation diminished over time. This difference was influenced by access recirculation (AR) and use of saline flushes. The median % difference between Vdprate and Watson V was reduced to 1% after adjusting for AR for the 22 sessions with ≤1 saline flush. The median coefficients of variation for serial determinations of Adjusted Chertow V, modeled V, urea generation rate, and eKt/Vref were 2.7%, 12.2%, 30.1%, and 16.4%, respectively. Because of comparatively higher modeled urea Vs, delivered eKt/Vref was lower than prescribed eKt/V, based on Watson V or Adjusted Chertow V, by 0.13 and 0.08 Kt/V units. The median absolute errors of prescribed eKt/V vs. delivered therapy (eKt/Vref) were not large and were similar in prescriptions based on the Adjusted Chertow V (0.127) vs. those based on various double-pool modeled urea volumes (∼0.127).
Equilibrated Kt/V can be derived using formal, double-pool UKM in intensive care unit ARF patients, with the venous rate equation providing a practical alternative. A target eKt/V can be prescribed to within a median absolute error of less than 0.14 Kt/V units using practical prescription algorithms. The causes of the increased apparent volume of urea distribution appear to be multifactorial and deserve further investigation.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>14633155</pmid><doi>10.1046/j.1523-1755.2003.00337.x</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0085-2538 |
| ispartof | Kidney international, 2003-12, Vol.64 (6), p.2298-2310 |
| issn | 0085-2538 1523-1755 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_71397452 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; ProQuest Central UK/Ireland; Alma/SFX Local Collection |
| subjects | Acute Kidney Injury - therapy Adult Algorithms Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Urea Nitrogen body water dialysis dose diffusion disequilibrium Emergency and intensive care: renal failure. Dialysis management Female Humans Intensive care medicine Intensive Care Units Kinetics Male Medical sciences Models, Biological Prescriptions protein catabolic rate Renal Dialysis urea Urea - blood urea distribution volume urea generation urea kinetic modeling urea rebound |
| title | Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T15%3A13%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prescribing%20an%20equilibrated%20intermittent%20hemodialysis%20dose%20in%20intensive%20care%20unit%20acute%20renal%20failure&rft.jtitle=Kidney%20international&rft.au=Kanagasundaram,%20Nigel%20S.&rft.aucorp=Project%20for%20the%20Improvement%20of%20the%20Care%20of%20Acute%20Renal%20Dysfunction%20(PICARD)%20Study%20Group&rft.date=2003-12-01&rft.volume=64&rft.issue=6&rft.spage=2298&rft.epage=2310&rft.pages=2298-2310&rft.issn=0085-2538&rft.eissn=1523-1755&rft.coden=KDYIA5&rft_id=info:doi/10.1046/j.1523-1755.2003.00337.x&rft_dat=%3Cproquest_cross%3E1012073791%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=210133053&rft_id=info:pmid/14633155&rft_els_id=S0085253815496012&rfr_iscdi=true |