Abstract
A standard for quantifying the hemodialysis dose has not yet been defined. Many authors suggest the use of an alternative method to Kt/V: the solute removal index (SRI).
We compared three methods based on blood-side urea determinations with the direct quantification method (DDQ) for estimating the delivered dialysis dose, expressed as SRI as well as Kt/V. Eight patients underwent three consecutive dialysis sessions, with the same dialytic efficiency. For each patient and each dialytic session the SRI and Kt/V were determined using the DDQ method and the single pool variable volume kinetic model, in its classical version (SPVV) as well by using the post-dialysis urea value determined 30 min after the end of the session (eqSPVV). Double pool Kt/V was also estimated by the Daugirdas-Schneditz rate equation.
Our results showed that the SPVV kinetic model significantly overestimated the delivered dialysis dose, the mean value of SRI and Kt/V were respectively 8.9% and 17% higher than those obtained by DDQ. The eqSPVV allowed the SRI to be estimated with a difference of -0.3% and Kt/V with a difference of -2% in comparison with DDQ. By using the Daugirdas-Schneditz rate of equation, which does not require blood samples to be drawn after the end of the session, the difference in Kt/V value was 3%.
Therefore, both the eqSPVV kinetic model and the Daugirdas method allow quantification of the delivered dialysis dose with results similar to those determined by DDQ, which cannot be routinely applied. Kt/V seems the best marker for dialytic doses quantification.
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