PMID- 9736788 OWN - NLM STAT- MEDLINE DCOM- 19981029 LR - 20180213 IS - 0253-5068 (Print) IS - 0253-5068 (Linking) VI - 16 IP - 4 DP - 1998 TI - Is post-dialysis urea rebound significant with long slow hemodialysis? PG - 187-96 AB - BACKGROUND: According to previous studies, postdialysis urea rebound (PDUR) is achieved within 30-90 min, leading to an overestimation of Kt/V of between 15 and 40% in 3- to 5-hour dialysis. The purpose of the study was to assess the impact of PDUR on the urea reduction ratio (URR), Kt/V and normal protein catabolic rate (nPCR) with long 8-hour slow hemodialysis. METHODS: This study was performed in 18 patients (13 males/5 females), 62.5 +/- 11.7 years of age, hemodialyzed for 3-265 months. Initial nephropathies were: 3 diabetes; 2 polycystic kidney disease; 3 interstitial nephritis; 2 nephrosclerosis; 3 chronic glomerulonephritis, and 5 undetermined. Residual renal function was negligible. The dialysis sessions were performed using 1- to 1.8-m2 cellulosic dialyzers during 8 h, 3 times a week. Blood flow was 220 ml/min, dialysate flow 500 ml/min, acetate or bicarbonate buffer was used. Serial measurements of the urea concentration were obtained before dialysis, immediately after dialysis (low flow at t = 0), and at 5, 10, 20, 30, 40, 60, 90 and 120 min, and before the next session. The low-flow method was used to evaluate the access recirculation, second-generation Daugirdas formulas for Kt/V, and Watson formulas for total body water volume estimation. The difference between the expected urea generation (UG) and urea measured after dialysis (global PDUR) defines net PDUR (n-PDUR). RESULTS: The n-PDUR usually became stable after 58 +/- 25 (30-90) min. Its mean value was 17 +/- 10% of the 30-second low-flow postdialysis urea (3.9 +/- 2 mmol/l). This small postdialysis urea value and the importance of UG in comparison with shorter dialysis justify the use of n-PDUR. Ignoring n-PDUR would lead to a significant 4% overestimation (p < 0.001) of the URR (79 +/- 7 vs. 76 +/- 8%), 12% of Kt/V (1.9 +/- 0.4 to 1.7 +/- 0.38) and 4% of the nPCR (1.1 +/- 0.3 to 1.05 +/- 0.3). n-PDUR correlated negatively with postdialysis urea (r = 0.45 p = 0.05), positively with URR (r = 0.31 p = 0.01) and Kt/V (r = 0.3 p = 0.03) but not with K, and negatively with the urea distribution volume (r = 0.33 p = 0.05). Mean total recirculation, ultrafiltration rate, predialysis urea levels and urea clearance did not correlate with n-PDUR. CONCLUSION: We found a significant PDUR in long-slow hemodialysis after a mean of 1 h after dialysis. This PDUR has a less important impact upon dialysis delivery estimation than short 3- to 5-hour hemodialysis, especially for the lower Kt/V or URR ranges. This is explained by the low-flux, high-efficiency, and long-term dialysis. Its inter-individual variability incites us to calculate PDUR on an individual basis. FAU - Jean, G AU - Jean G AD - Centre de Rein Artificiel, Tassin, France. GJEAN14357@aol.com FAU - Chazot, C AU - Chazot C FAU - Charra, B AU - Charra B FAU - Terrat, J C AU - Terrat JC FAU - Vanel, T AU - Vanel T FAU - Calemard, E AU - Calemard E FAU - Laurent, G AU - Laurent G LA - eng PT - Clinical Trial PT - Controlled Clinical Trial PT - Journal Article PL - Switzerland TA - Blood Purif JT - Blood purification JID - 8402040 RN - 8W8T17847W (Urea) SB - IM MH - Aged MH - Aged, 80 and over MH - Female MH - Humans MH - Linear Models MH - Male MH - Middle Aged MH - Renal Dialysis/*methods MH - Time Factors MH - Treatment Outcome MH - Urea/*blood EDAT- 1998/09/16 02:04 MHDA- 2000/08/16 11:00 CRDT- 1998/09/16 02:04 PHST- 1998/09/16 02:04 [pubmed] PHST- 2000/08/16 11:00 [medline] PHST- 1998/09/16 02:04 [entrez] AID - bpu16187 [pii] AID - 10.1159/000014334 [doi] PST - ppublish SO - Blood Purif. 1998;16(4):187-96. doi: 10.1159/000014334.