scholarly journals Predicting Residual Function in Hemodialysis and Hemodiafiltration – A Population Kinetic, Decision Analytic Approach

2019 ◽  
Author(s):  
Mohammad I Achakzai ◽  
Christos Argyropoulos ◽  
Maria-Eleni Roumelioti
Keyword(s):  
Residual Renal Function ◽  
Decision Curve Analysis ◽  
High Discrimination ◽  
On Line ◽  
Population Kinetic ◽  
Public Dataset ◽  
Beta 2 Microglobulin ◽  
Dialysis Frequency ◽  
Real Patients ◽  
Human Dataset

AbstractIn this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of Beta 2 Microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations derived entirely from computer simulations and advanced statistical modeling, and had extremely high discrimination (AUC 0.888 – 0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized pre and post dialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions that for individualizing dialysis frequency in patients with preserved RRF.

scholarly journals Predicting Residual Function in Hemodialysis and Hemodiafiltration – A Population Kinetic, Decision Analytic Approach

2019 ◽  
Author(s):  
Mohammad Achakzai ◽  
Christos Argyropoulos ◽  
Maria Eleni Roumelioti
Keyword(s):  
Residual Renal Function ◽  
Decision Curve Analysis ◽  
High Discrimination ◽  
On Line ◽  
Population Kinetic ◽  
Public Dataset ◽  
Beta 2 Microglobulin ◽  
Dialysis Frequency ◽  
Real Patients ◽  
Human Dataset

In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of Beta 2 Microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations derived entirely from computer simulations and advanced statistical modeling, and had extremely high discrimination (AUC 0.808 – 0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized pre and post dialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions that for individualizing dialysis frequency in patients with preserved RRF.

scholarly journals Predicting Residual Function in Hemodialysis and Hemodiafiltration—A Population Kinetic, Decision Analytic Approach

2019 ◽  
Vol 8 (12) ◽  
pp. 2080
Author(s):  
Muhammad I. Achakzai ◽  
Christos Argyropoulos ◽  
Maria-Eleni Roumelioti
Keyword(s):  
Area Under The Curve ◽  
Residual Renal Function ◽  
Decision Curve Analysis ◽  
High Discrimination ◽  
On Line ◽  
Population Kinetic ◽  
Public Dataset ◽  
Beta 2 Microglobulin ◽  
Real Patients ◽  
Human Dataset

In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of beta 2 microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations were derived entirely from computer simulations and advanced statistical modeling and had extremely high discrimination (Area Under the Curve, AUC 0.888–0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized predialysis and postdialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions for individualizing dialysis prescriptions in patients with preserved RRF.

Long-Term On-Line Hemodiafiltration Reduces Predialysis Beta-2-Microglobulin Levels in Chronic Hemodialysis Patients

2001 ◽  
Vol 19 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Chun-Liang Lin ◽  
Chih-Wei Yang ◽  
Chin-Chen Chiang ◽  
Ching-Tung Chang ◽  
Chiu-Ching Huang
Keyword(s):  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
On Line ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Remarkable Removal of Beta-2-Microglobulin by On-Line Hemodiafiltration

1998 ◽  
Vol 18 (2) ◽  
pp. 105-108 ◽  
Author(s):  
Willy Lornoy ◽  
Ignace Becaus ◽  
Jean-Marie Billiouw ◽  
Luc Sierens ◽  
Paul van Malderen
Keyword(s):  
On Line ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Single Session and Weekly Beta 2-Microglobulin Removal with Different Dialytic Procedures: Comparison between High-Flux Standard Bicarbonate Hemodialysis, Post-Dilution Hemodiafiltration, Short Frequent Hemodialysis with NxStage Technology and Automated Peritoneal Dialysis

2019 ◽  
Vol 48 (1) ◽  
pp. 86-96 ◽  
Author(s):  
Chiara Carla Maria Brunati ◽  
Francesca Gervasi ◽  
Mara Cabibbe ◽  
Federica Ravera ◽  
Alberto Menegotto ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Removal Rate ◽  
High Flux ◽  
Automated Peritoneal Dialysis ◽  
Single Session ◽  
Daily Dialysis ◽  
On Line ◽  
Beta 2 Microglobulin ◽  
Few Data ◽  
The Impact

Background: NxStage System One cycler (NSO) is a widespread system for home daily dialysis. Few data are available on the impact of this “low dialysate volumes system” on the removal rate of poorly diffusible, time-dependent solutes like β2-microglobulin (β2M). Methods: Single-session and weekly balances of β2M were performed and compared in 12 patients on daily NSO, 13 patients on standard high-flux bicarbonate dialysis (BHD), 5 patients on standard post-dilution on line hemodiafiltration (HDF), and 13 patients on automated peritoneal dialysis (APD). Results: Intradialytic fall of plasma water β2M levels (corrected for rebound) was 65.2 ± 2.6% in HDF, 49.8 ± 9.1% in BHD, and 32.3 ± 6.4% in NSO (p < 0.001 between all groups). Single treatment dialysate removal was much less in APD (19.4 ± 20.4 mg, p < 0.001) than in any extracorporeal technologies, and was less in NSO (126.2 ± 35.6 mg, p < 0.001) than in BHD (204.9 ± 53.4 mg) and HDF (181.9 ± 37.6 mg), with no differences between the latter 2; however weekly removal was higher in NSO (757.3 ± 213.7 mg, p < 0.04) than in BHD (614.8 ± 160.3 mg) and HDF (545.8 ± 112.8 mg). Extrapolated β2M adsorption to the membrane was negligible in BHD, 14.7 ± 9.5% of total removal in HDF and 18.3 ± 18.5% in NSO. Integration of single session data into a weekly efficiency indicator (K × t) showed total volume of plasma cleared in NSO (33.4 ± 7.7 L/week) to be higher than in BHD (26.9 ± 7.2 L/week, p < 0.01) and not different than in HDF (36.2 ± 4.7 L/week); it was negligible (3.2 ± 1.0) in APD. Conclusions: Weekly β2M removal efficiency proved equal and highest in HDF and NSO (at a 6/week prescription), slightly lesser in BHD and lowest in APD.

Serum Beta-2-Microglobulin Level and Residual Renal Function in Peritoneal Dialysis

Nephron ◽  
1993 ◽  
Vol 65 (3) ◽  
pp. 469-471 ◽  
Author(s):  
Gianpaolo Amici ◽  
Giovambattista Virga ◽  
Giorgio Da Rin ◽  
Stefano Grandesso ◽  
Alberto Vianello ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Beta 2 ◽  
Beta 2 Microglobulin

scholarly journals MP547CYSTATIN C AND BETA-2 MICROGLOBULIN - VALUABLE BIOMARKERS OF RESIDUAL RENAL FUNCTION IN PERITONEAL DIALYSIS

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii629-iii630
Author(s):  
Carla Moreira ◽  
Liliana Cunha ◽  
Maria Carvalho ◽  
José Oliveira ◽  
Olívia Santos ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Beta 2 ◽  
Beta 2 Microglobulin

scholarly journals The effect of membrane biocompatibility on plasma beta 2-microglobulin levels in chronic hemodialysis patients.

1996 ◽  
Vol 7 (3) ◽  
pp. 472-478
Author(s):  
R M Hakim ◽  
R L Wingard ◽  
L Husni ◽  
R A Parker ◽  
T F Parker
Keyword(s):  
Renal Function ◽  
Medical Center ◽  
Residual Renal Function ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
High Flux ◽  
Rate Of Increase ◽  
Beta 2 ◽  
Lower Plasma Level ◽  
Beta 2 Microglobulin

Several studies have shown that patients who have been dialyzed with high-flux biocompatible membranes have a lower plasma level of beta 2-microglobulin and a lower incidence of amyloid disease compared with patients who have been dialyzed with low-flux bioincompatible membranes. However, because high-flux membranes are associated with significant dialytic removal of beta 2-microglobulin, the specific role of membrane biocompatibility in influencing the rate of increase of beta 2-microglobulin has not been previously determined. This study investigated the effect of biocompatibility on the rate of increase of plasma levels of beta 2-microglobulin in 159 new hemodialysis patients from 13 dialysis centers (ten centers affiliated with Dallas Nephrology Associates and three with Vanderbilt University Medical Center) by using two low-flux membranes with widely different biocompatibilities. These patients were prospectively randomized to be dialyzed with either a low-flux biocompatible membrane or a low-flux bioincompatible membrane. Plasma beta 2-microglobulin levels were measured at 0, 3, 6, 9, 12, and 18 months. Sixty-six patients completed the 18-month study. Plasma beta 2-microglobulin increased in all patients; however, the increase was not significantly different from baseline at any time point in the group that used the biocompatible membrane. In this group, beta 2-microglobulin increased from (mean +/- SD) 27.8 +/- 14.8 mg/L to 34.0 +/- 10.0 mg/L at 18 months (P = not significant), and the mean increase at 18 months was 2.6 +/- 14.7 mg/L. In contrast, the increase in plasma beta 2-microglobulin level in the bioincompatible membrane group became significant in Month 6 when the levels had increased from a baseline of 24.8 +/- 9.6 mg/L to 29.5 +/- 12.2 mg/L (P < 0.001); these increases continued to be significant until Month 18, when serum beta 2-microglobulin reached 36.8 +/- 13.9 mg/L with an average increase of 11.8 +/- 11.2 mg/L (P < 0.0001). The higher rate of plasma B2-microglobulin increase in the group that had been dialyzed with the bioincompatible membrane was also evident when only patients who had completed the study were analyzed. There were no significant differences in the actual level of beta 2-microglobulin or in residual renal function between the two groups during the 18 months of the study. It was concluded that over a period of 18 months, the use of biocompatible membranes, even in the low-flux configuration, is associated with a significantly slower increase in plasma beta 2-microglobulin, independent of the influence of residual renal function.

Citrate versus Acetate-Based Dialysate in On-Line Haemodiafiltration. A Prospective Cross-Over Study

2015 ◽  
Vol 39 (1-3) ◽  
pp. 181-187 ◽  
Author(s):  
Manuel Molina Nuñez ◽  
Rosa de Alarcón ◽  
Susana Roca ◽  
Gracia Álvarez ◽  
María Soledad Ros ◽  
...  
Keyword(s):  
Anticoagulant Effect ◽  
Acid Base ◽  
C Protein ◽  
Inflammatory Parameters ◽  
Ionic Calcium ◽  
On Line ◽  
Acid Base Status ◽  
Beta 2 ◽  
Two Phases ◽  
Beta 2 Microglobulin

Background and Aims: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect and improves biocompatibility. This study examines the effect of CD on dialysis efficiency, coagulation, acid-base status, electrolytes, and inflammation in patients in on-line hemodiafiltration (OL-HDF). Methods: 35 patients in OL-HDF were enrolled in a prospective, cross-over study for a 24-week period and two phases alternating CD and acetate dialysate fluid (AD). Parameters on study were predialysis levels of bicarbonate and ionic calcium, reactive C Protein (CRP), and beta-2 microglobulin (B2MG) and postdialysis levels of activated tromboplastine time, bicarbonate, and ionized calcium. Results: No significant differences in coagulation parameters, pH, and predialysis bicarbonate were found. The postdialysis bicarbonate and postdialysis calcium were lower with CD. Dialysis efficiency was greater with CD. Regarding inflammatory parameters, both CRP and B2MG were lower using CD. Conclusion: The use of CD is safe and effective in OL-HDF, and it improves dialysis efficacy, postdialysis alkalosis, and inflammation.

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