Abstract: FR-PO473
Hybrid Conductivity/Urea Kinetic Modeling Approach to Calculate Kt/V and Normalized Protein Catabolic Rate with Reduced Need for Postdialysis BUN
Session Information
- Hemodialysis and Frequent Dialysis - IV
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Raimann, Jochen G., Renal Research Institute, New York, New York, United States
- Ye, Xiaoling, Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Daugirdas, John T., University of Illinois College of Medicine, Chicago, Illinois, United States
Background
We present a novel hybrid conductivity /urea kinetic modeling (UKM) method to calculate Kt/V and normalized protein catabolic rate (nPCR) that markedly reduces the need for routine post-dialysis BUN measurement.
Methods
Data from midweek dialysis sessions of patients monitored over a 2-year period were studied. During the initial 8 months (baseline), measured average conductivity clearance, Kecn, and URR were entered into a UKM program to calculate a median patient-specific modeled solute distribution volume, Vcal. During months 9–16 (period 1) and 17–24 (period 2) Kt/V was computed by UKM using URR and estimated dialyzer clearance (conventional method) as well as by the proposed method, which can compute Kt/V using Vcal along with the treatment-specific average Kecn without the need for a postdialysis SUN.
Results
In 1087 patients, the mean (SD) of the median single-pool Kt/V by the conventional method were 1.62 (0.245), 1.66 (0.24) and 1.67 (0.25) during baseline, periods 1 and 2, respectively. During periods 1 and 2, median Kt/V with the new method averaged 1.64 (0.24) and 1.65 (0.24), respectively; differences between the new method and conventional method averaged –0.6% (8.0) and –0.8% (8.4), respectively. nPCR rate was comparable between the two methods.
Figure: Bland-Altman plot of the bias in median (single-pool) Kt/V using the proposed method compared to the KoA based classic method during Months 9 to 24.
Conclusion
The novel hybrid conductivity-UKM based method of monitoring hemodialysis adequacy is non-inferior to the standard approach. It has the potential to avoid Kt/V errors related to improper peridialytic BUN sampling.