PMID- 12637647
OWN - NLM
STAT- MEDLINE
DCOM- 20031125
LR  - 20190513
IS  - 0931-0509 (Print)
IS  - 0931-0509 (Linking)
VI  - 18
IP  - 4
DP  - 2003 Apr
TI  - Kinetics and dosing predictions for daily haemofiltration.
PG  - 769-76
AB  - BACKGROUND: Thrice-weekly haemofiltration affords excellent outcome when it is 
      used to treat chronic renal failure patients. Daily haemofiltration (DHF) has 
      recently been proposed as a more intensive therapy option, but the total 
      ultrafiltration or exchange volume (replacement volume plus net ultrafiltration 
      volume) requirements for adequate solute clearances during this novel therapy are 
      unknown. METHODS: We calculated theoretical solute kinetic profiles during six 
      times per week DHF for comparison with those during thrice-weekly haemodialysis 
      using a high-flux dialyser (HFHD) or during continuous ambulatory peritoneal 
      dialysis (CAPD). HFHD and CAPD were chosen for comparison because K/DOQI 
      guidelines have defined adequate treatment doses for these therapies. 
      Steady-state concentrations were calculated using a two-compartment model of an 
      anuric patient with 35 l of total body water for five solutes: urea, creatinine, 
      vitamin B(12), inulin and beta(2)-microglobulin. Solute distribution volumes and 
      generation rates were taken from the literature, and excess fluid (1 l/day) was 
      assumed to accumulate in and be removed from the extracellular fluid compartment. 
      Theoretical predictions of solute clearance were compared for a 15-l exchange 
      volume/session during DHF, urea Kt/V of 3.6/week during HFHD and urea Kt/V of 
      2.0/week during CAPD as solute-specific values of the equivalent renal clearance 
      (EKR) and standard Kt/V (stdKt/V) recently defined by Gotch. Additional 
      comparisons of solute clearances were performed between DHF and other daily 
      therapies including six times per week short daily haemodialysis (SDHD) and six 
      times per week nocturnal haemodialysis (NHD). RESULTS: The calculated results 
      predict that: (i) urea clearance during DHF with an exchange volume of 90 l/week 
      (6x15 l) is equivalent to those during HFHD and CAPD based on urea stdKt/V; and 
      (ii) middle molecule clearances during DHF exceed those achieved during HFHD and 
      CAPD based on either EKR or stdKt/V. As expected, DHF therapy was inferior 
      regarding the clearance of urea and other small solutes to SDHD and NHD; however, 
      DHF therapy was superior to SDHD regarding the clearance of larger middle 
      molecules, approaching the clearances achieved by NHD. CONCLUSIONS: We predict 
      that an exchange volume of approximately 40% of total body water (15/35 l=43%) 
      per session will provide adequate clearance of small solutes and substantial 
      clearance of middle molecules during six times per week DHF therapy. These 
      theoretical predictions require clinical validation.
FAU - Leypoldt, John K
AU  - Leypoldt JK
AD  - Research Service, Salt Lake City VA Health Care System, Salt Lake City, UT, USA. 
      ken.leypoldt@hsc.utah.edu
FAU - Jaber, Bertrand L
AU  - Jaber BL
FAU - Lysaght, Michael J
AU  - Lysaght MJ
FAU - McCarthy, James T
AU  - McCarthy JT
FAU - Moran, John
AU  - Moran J
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Dialysis Solutions)
SB  - IM
MH  - *Blood Urea Nitrogen
MH  - Dialysis Solutions/chemistry/*pharmacokinetics
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Hemofiltration/*methods
MH  - Humans
MH  - Kidney Function Tests
MH  - Male
MH  - Peritoneal Dialysis, Continuous Ambulatory/methods
MH  - Predictive Value of Tests
MH  - Sensitivity and Specificity
EDAT- 2003/03/15 04:00
MHDA- 2003/12/03 05:00
CRDT- 2003/03/15 04:00
PHST- 2003/03/15 04:00 [pubmed]
PHST- 2003/12/03 05:00 [medline]
PHST- 2003/03/15 04:00 [entrez]
AID - 10.1093/ndt/gfg019 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2003 Apr;18(4):769-76. doi: 10.1093/ndt/gfg019.