Estimation of delivered dialysis dose by on-line monitoring of the ultraviolet absorbance in the spent dialysate

2003 ◽  
Vol 41 (5) ◽  
pp. 1026-1036 ◽  
Author(s):  
Fredrik Uhlin ◽  
Ivo Fridolin ◽  
Lars-Göran Lindberg ◽  
Martin Magnusson
Keyword(s):  
Dialysis Dose ◽  
Ultraviolet Absorbance ◽  
On Line ◽  
Spent Dialysate

scholarly journals Comparison of dialysis dose through real-time Kt/V by ultraviolet absorbance of spent dialysate, single-pool Daugirdas II, and Kt/BSA according to sex and age

2020 ◽  
Author(s):  
Mauro Sergio Martins Marrocos ◽  
Christine Nastri Castro ◽  
Wilder Araujo Barbosa ◽  
Andressa Monteiro Sizo ◽  
Fernanda Teles Rodrigues ◽  
...  
Keyword(s):  
Real Time ◽  
Body Surface ◽  
Conversion Factor ◽  
Pearson Correlation ◽  
Dry Weight ◽  
Volume Distribution ◽  
Dialysis Dose ◽  
Men And Women ◽  
Ultraviolet Absorbance ◽  
Spent Dialysate

ABSTRACT Background: Kt/V OnLine (Kt/VOL) avoids inaccuracies associated with the estimation of urea volume distribution (V). The study aimed to compare Kt/VOL, Kt/V Daugirdas II, and Kt/BSA according to sex and age. Methods: Urea volume distribution and body surface area were obtained by Watson and Haycock formulas in 47 patients. V/BSA was considered as a conversion factor from Kt/V to Kt/BSA. Dry weight was determined before the study. Kt/VOL was obtained on DIALOG machines. Results: Pearson correlation between Kt/VOL vs Kt/VII and Kt/VOL vs Kt/BSA was significant for males (r = 0.446, P = 0.012 and r = -0.476 P = 0.007) and individuals < 65 years (0.457, P = 0.019 and -0.549 P = 0.004), but not for females and individuals ≥ 65 years. V/BSA between individuals < 65 and individuals ≥ 65 years were 18.28 ± 0.15 and 18.18 ± 0.16 P = 0.000). No agreement between Kt/VII vs Kt/BSA. Men and individuals > 65 years received a larger dialysis dose than, respectively, females and individuals < 65 years, in the comparison between Kt/VOL versus Kt/VII. V/BSA ratios among men and women were respectively 18.29 ± 0.13 and 18.12 ± 0.15 P = 0.000. Conclusions: Kt/VOL allows recognition of real-time dose regardless of sex and age.

A New Biosensor for Continuous Monitoring of the Spent Dialysate Urea Level in Standard Hemodialysis

1998 ◽  
Vol 21 (3) ◽  
pp. 147-150 ◽  
Author(s):  
P. Calzavara ◽  
G. Calconi ◽  
G. Da Rin ◽  
E. Canini ◽  
F Paolini
Keyword(s):  
Continuous Monitoring ◽  
Linear Regression Analysis ◽  
Simple Linear Regression ◽  
Excellent Correlation ◽  
Buffer Solution ◽  
Dialysis Dose ◽  
Bicarbonate Buffer ◽  
Differential Measurement ◽  
On Line ◽  
Spent Dialysate

This study gives the results in terms of precision and repeatability of a new on-line urea monitoring system (Ureascan P2 Hospal) capable of measuring the urea concentrations in the spent dialysate. The Ureascan P2 Hospal (UP2H), fitted on single-pass dialysis machines (Integra-Hospal), functions by the presence of a disposable mini-reactor containing urease. The passage through the reactor of a minimum quantity of spent dialysate from the filter diluted with a pH 7 buffer solution (1 ml/min) increases its ionic strength, which is detected by a differential measurement of conductivity in proportion to the urea concentration in the dialysis liquid. We studied 13 dialysis sessions, with bicarbonate buffer, in 8 anuric patients. From 4 to 7 dialysate samples were taken during each treatment to determine the urea and 65 samples were analysed overall. Urea values from the UP2H were compared with those measured on the Dimension Du Pont analyser. Simple linear regression analysis showed an excellent correlation between the 2 measuring methods (r=0.987; p<0.001). The Bland-Altman test gave an average difference between the urea values measured with the UP2H and in the laboratory of 1.3±1.2 mg/dl. The agreement limits between 2 SD were - 1.2 mg/dl and +3.8 mg/dl respectively. In conclusion, the UP2H we have developed has proved to be a reliable and very useful instrument for adapting, through the urea kinetic mathematical models, the dialysis dose for individual patients.

scholarly journals Determination of the delivered hemodialysis dose using standard methods and on-line clearance monitoring

2006 ◽  
Vol 63 (8) ◽  
pp. 743-747 ◽  
Author(s):  
Vlastimir Vlatkovic ◽  
Biljana Stojimirovic
Keyword(s):  
Cumulative Effect ◽  
Chronic Hemodialysis ◽  
Reduction Ratio ◽  
The Other ◽  
Treatment Quality ◽  
Monitoring Methods ◽  
Dialysis Dose ◽  
Co Morbidity ◽  
On Line ◽  
Urea Reduction Ratio

Background/aim: Delivered dialysis dose has a cumulative effect and significant influence upon the adequacy of dialysis, quality of life and development of co-morbidity at patients on dialysis. Thus, a great attention is given to the optimization of dialysis treatment. On-line Clearance Monitoring (OCM) allows a precise and continuous measurement of the delivered dialysis dose. Kt/V index (K = dialyzer clearance of urea; t = dialysis time; V = patient's total body water), measured in real time is used as a unit for expressing the dialysis dose. The aim of this research was to perform a comparative assessment of the delivered dialysis dose by the application of the standard measurement methods and a module for continuous clearance monitoring. Methods. The study encompassed 105 patients who had been on the chronic hemodialysis program for more than three months, three times a week. By random choice, one treatment per each controlled patient was taken. All the treatments understood bicarbonate dialysis. The delivered dialysis dose was determined by the calculation of mathematical models: Urea Reduction Ratio (URR) singlepool index Kt/V (spKt/V) and by the application of OCM. Results. Urea Reduction Ratio was the most sensitive parameter for the assessment and, at the same time, it was in the strongest correlation with the other two, spKt/V indexes and OCM. The values pointed out an adequate dialysis dose. The URR values were significantly higher in women than in men, p < 0.05. The other applied model for the delivered dialysis dose measurement was Kt/V index. The obtained values showed that the dialysis dose was adequate, and that, according to this parameter, the women had significantly better dialysis, then the men p < 0.05. According to the OCM, the average value was slightly lower than the adequate one. The women had a satisfactory dialysis according to this index as well, while the delivered dialysis dose was insufficient in men. The difference between the women and the men was significant. Conclusion. The application of OCM has shown that it is the most rigorous parameter for the assessment of adequacy and that its regular use would contribute to increasing of the delivered dialysis dose and improvement of the treatment quality.

scholarly journals Multicenter clinical validation of an on-line monitor of dialysis adequacy.

1996 ◽  
Vol 7 (3) ◽  
pp. 464-471
Author(s):  
T A Depner ◽  
P R Keshaviah ◽  
J P Ebben ◽  
P F Emerson ◽  
A J Collins ◽  
...  
Keyword(s):  
Solute Concentration ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Automated Method ◽  
Baxter Healthcare ◽  
Significant Difference ◽  
Urea Kinetics ◽  
Nitrogen Concentrations ◽  
On Line ◽  
Paired Analysis

Quantitation of hemodialysis by measuring changes in blood solute concentration requires careful timing when taking the postdialysis blood sample to avoid errors from postdialysis rebound and from recirculation of blood through the access device. It also requires complex mathematical interpretation to account for solute disequilibrium in the patient. To circumvent these problems, hemodialysis can be quantified and its adequacy assessed by direct measurement of the urea removed in the dialysate. Because total dialysate collection is impractical, an automated method was developed for measuring dialysate urea-nitrogen concentrations at frequent intervals during treatment. A multicenter clinical trial of the dialysate monitoring device, the Biostat 1000 (Baxter Healthcare Corporation, McGaw Park, IL) was conducted to validate the measurements of urea removed, the delivered dialysis dose (Kt/V), and net protein catabolism (PCR). The results were compared with a total dialysate collection in each patient. During 29 dialyses in 29 patients from three centers, the paired analysis of urea removed, as estimated by the dialysate monitor compared with the total dialysate collection, showed no significant difference (14.7 +/- 4.7 g versus 14.8 +/- 5.1 g). Similarly, measurements of Kt/V and PCR showed no significant difference (1.30 +/- 0.18 versus 1.28 +/- 0.19, respectively, for Kt/V and 42.3 +/- 15.7 g/day versus 52.2 +/- 17.4 g/day for PCR). When blood-side measurements during the same dialyses were analyzed with a single-compartment, variable-volume model of urea kinetics, Kt/V was consistently overestimated (1.49 +/- 0.29/dialysis, P < 0.001), most likely because of failure to consider urea disequilibrium. Because urea disequilibrium is difficult to quantitate during each treatment, dialysate measurements have obvious advantages. The dialysate monitor eliminated errors from dialysate bacterial contamination, simplified dialysate measurements, and proved to be a reliable method for quantifying and assuring dialysis adequacy.

Dialysis dose and nutrition assessment by optical on-line dialysis adequacy monitor

2009 ◽  
Vol 72 (10) ◽  
pp. 303-311 ◽  
Author(s):  
M. Luman ◽  
J. Jerotskaja ◽  
K. Lauri ◽  
I. Fridolin
Keyword(s):  
Nutrition Assessment ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
On Line

Mathematical Modeling of Different Molecule Removal on On-Line Haemodiafiltration: Influence of Dialysis Duration and Infusion Flow

2015 ◽  
Vol 39 (4) ◽  
pp. 288-296 ◽  
Author(s):  
Francisco Maduell ◽  
Juan Sanchez ◽  
Marta Net ◽  
Miquel Gomez ◽  
Jose M. Gonzalez ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Treatment Time ◽  
Compartment Model ◽  
Dialysis Dose ◽  
Β2 Microglobulin ◽  
Dialysis Duration ◽  
Two Compartment Model ◽  
On Line ◽  
The Impact ◽  
Kinetics Of

Background: In a previous study on a nocturnal, every-other-day online haemodiafiltration scheme, different removal patterns were observed for urea, creatinine, β2-​microglobulin, myoglobin and prolactin. The aim of this study was to evaluate the influence of dialysis duration and infusion flow (Qi) on the removal of different molecular weight (MW) solutes, and to quantify the effect of the different treatments on the kinetics of the solutes by using a classical two-compartment model. Methods: This prospective, in-center study was carried out in 10 patients on a nocturnal, every-other-day online post-dilution haemodiafiltration program. Each patient received four dialysis sessions with different conditions, two 4-h sessions (with infusion flows of 50 or 100 ml/min) and two 8-h sessions (with infusion flows of 50 or 100 ml/min). To analyze the solute kinetics, blood samples were obtained hourly during the dialysis treatments and in the first 3 h post-dialysis. Results: Removal patterns differed in the molecules studied, which were quantified by means of the two-compartment mathematical model. The main results show the impact of dialysis duration on the removal of low molecular weight molecules (urea and creatinine), while the impact of Qi is clearly shown for high molecular weight molecules (myoglobin and prolactin). For middle molecular weight solutes, such as β2-microglobulin, both factors (duration and Qi) enhance the removal efficiency of the dialyzer. Conclusions: Our study evaluates experimentally and mathematically how treatment time and infusion flow affect the filtration of solutes of different MW during post-dilution haemodiafiltration. The results provided by the present study should help physicians to select and individualise the most appropriate schedules to deliver an optimum diffusive and convective dialysis dose for each patient.

scholarly journals Real-time Kt/V determination by ultraviolet absorbance in spent dialysate: technique validation

2010 ◽  
Vol 78 (9) ◽  
pp. 920-925 ◽  
Author(s):  
Alex Castellarnau ◽  
Michael Werner ◽  
Roman Günthner ◽  
Marten Jakob
Keyword(s):  
Real Time ◽  
Ultraviolet Absorbance ◽  
Spent Dialysate
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