PMID- 8659502
OWN - NLM
STAT- MEDLINE
DCOM- 19960801
LR  - 20190815
IS  - 0272-6386 (Print)
IS  - 0272-6386 (Linking)
VI  - 27
IP  - 2
DP  - 1996 Feb
TI  - Postdialysis urea rebound: determinants and influence on dialysis delivery in 
      chronic hemodialysis patients.
PG  - 253-61
AB  - We measured postdialysis urea rebound (PDUR) 30 minutes after dialysis in 92 
      chronic hemodialysis patients. The impact of PDUR on the estimation of dialysis 
      delivery assessed by urea reduction ratio and Kt/V was evaluated. Total 
      recirculation, access plus cardiopulmonary, was measured at the end of dialysis 
      with the two-needle low blood flow method. The mean age of the 92 patients (49 
      men and 43 women) was 59.6 +/- 1.4 years. Thirty-eight patients had been 
      receiving erythropoietin therapy for more than 3 months. Fifteen patients had 
      central venovenous access and 77 had peripheral arteriovenous access. Sixty-five 
      patients were dialyzed using hemophan membranes and 27 were dialyzed using 
      polyacrylonitrile membranes. The mean blood flow rate was 240 +/- 28 mL/min and 
      the mean length of the hemodialysis sessions was 3.6 +/- 0.1 hours. Kt/V was 
      calculated with Daugirdas' second-generation formula. The mean PDUR was 16.6% +/- 
      0.8% (range, 2% to 44%) (n = 92), and significantly decreased the mean urea 
      reduction ratio from 61.7% +/- 0.8% to 55.5% +/- 0.9%, the mean Kt/V from 1.14 
      +/- 0.03 to 0.97 +/- 0.02, and the mean protein catabolic rate from 1.06 +/- 0.04 
      to 0.98 +/- 0.02 (P = 0.0001). The effective Kt/V at 30 minutes postdialysis was 
      well predicted by using a recently proposed equation: eKt/V30 = Kt/Vsp - (0.6 x 
      Kt/Vsp/t) + 0.03, with a mean value corresponding also to 0.97 +/- 0.02. However, 
      this estimation was less predictive in patients with very high PDUR. Moreover, 
      PDUR showed only a weak negative correlation with dialysis session length (r = 
      -0.28) and predialysis patient weight (r = -0.29), and showed no correlation with 
      predialysis serum urea level or with blood flow rate. However, dialysis 
      efficiency, as assessed by K/V, presented a correlation of 0.54 with both PDUR 
      and the difference in Kt/V when using urea immediately postdialysis and at 30 
      minutes. The mean total recirculation was 7.4% +/- 0.6% (n = 86). Postdialysis 
      urea rebound, calculated between 30 or 120 seconds and 30 minutes after dialysis 
      to deduce the influence of recirculations, was reduced but remained important 
      with a mean of 11.8% +/- 0.7%. Thus, total recirculation contributed to nearly 
      30% of PDUR. The 24 patients with PDUR > or = 20% were compared with the 68 
      patients with PDUR lower than 20%: women and patients with higher K/V and higher 
      total recirculation presented greater PDUR. Because of relatively few predictive 
      factors for PDUR, its potential considerable impact on dialysis delivery 
      estimation, and the influence of recirculations on the total PDUR amount, total 
      recirculation and PDUR should be determined on an individual basis in chronic 
      hemodialysis patients. The equation proposed to estimate effective Kt/V at 30 
      minutes is accurate in most patients with PDUR lower than 30% and is a simple 
      alternative.
FAU - Leblanc, M
AU  - Leblanc M
AD  - Hopital du Sacre-Coeur de Montreal, Universite de Montreal, Quebec, Canada.
FAU - Charbonneau, R
AU  - Charbonneau R
FAU - Lalumiere, G
AU  - Lalumiere G
FAU - Cartier, P
AU  - Cartier P
FAU - Deziel, C
AU  - Deziel C
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am J Kidney Dis
JT  - American journal of kidney diseases : the official journal of the National Kidney 
      Foundation
JID - 8110075
RN  - 0 (Acrylic Resins)
RN  - 0 (Biocompatible Materials)
RN  - 0 (Membranes, Artificial)
RN  - 106254-94-8 (Hemophan)
RN  - 25014-41-9 (polyacrylonitrile)
RN  - 8W8T17847W (Urea)
RN  - 9004-34-6 (Cellulose)
SB  - IM
MH  - Acrylic Resins
MH  - Biocompatible Materials
MH  - Body Weight
MH  - Case-Control Studies
MH  - Cellulose/analogs & derivatives
MH  - Female
MH  - Humans
MH  - Kidney Failure, Chronic/blood/*therapy
MH  - Male
MH  - Membranes, Artificial
MH  - Middle Aged
MH  - *Renal Dialysis/instrumentation/methods
MH  - Time Factors
MH  - Urea/blood/*metabolism
EDAT- 1996/02/01 00:00
MHDA- 1996/02/01 00:01
CRDT- 1996/02/01 00:00
PHST- 1996/02/01 00:00 [pubmed]
PHST- 1996/02/01 00:01 [medline]
PHST- 1996/02/01 00:00 [entrez]
AID - S0272-6386(96)90549-1 [pii]
AID - 10.1016/s0272-6386(96)90549-1 [doi]
PST - ppublish
SO  - Am J Kidney Dis. 1996 Feb;27(2):253-61. doi: 10.1016/s0272-6386(96)90549-1.