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Which comes first, Kt/V or PCR--chicken or egg?
R M Lindsay1, E Spanner, R P Heidenheim
1Artificial Kidney Research Centre, Victoria Hospital, London, Ontario, Canada.
Kidney International. Supplement
|October 1, 1992
Summary
Increasing urea kinetic modeling (Kt/V) in hemodialysis patients with low protein catabolic rate (PCR) significantly improved PCR. This suggests Kt/V influences PCR, offering a target for nutritional management in dialysis patients.
Area of Science:
- Nephrology
- Biochemistry
- Clinical Nutrition
Background:
- Protein catabolic rate (PCR) is a key indicator of nutritional status in hemodialysis patients.
- The relationship between PCR and urea kinetic modeling (Kt/V) is not fully understood.
- Previous hypotheses suggested PCR is dependent on Kt/V (urea).
Purpose of the Study:
- To investigate the hypothesis that PCR is dependent on Kt/V (urea).
- To determine if increasing Kt/V can improve PCR in hemodialysis patients with persistently low PCR.
- To evaluate the impact of adjusted Kt/V on nutritional markers.
Main Methods:
- A randomized controlled trial involving 30 hemodialysis patients with PCR < 1.
- Patients were assigned to an experimental group with increased Kt/V or a control group with unchanged Kt/V.
- Urea kinetic modeling was monitored monthly for three months.
Main Results:
- The experimental group showed a significant increase in Kt/V from 0.82 to 1.32 (P = 0.000) and PCR from 0.81 to 1.02 (P = 0.005).
- The control group maintained stable Kt/V (0.82 to 0.87) and PCR (0.87 to 0.86) (P = NS).
- Mean increments in Kt/V and PCR in the experimental group were 0.49 and 0.21, respectively (P < 0.005).
Conclusions:
- Increasing Kt/V in hemodialysis patients with low PCR can significantly improve PCR.
- This suggests that Kt/V is a determinant of PCR in this patient population.
- Optimizing Kt/V may be a viable strategy for nutritional management in hemodialysis patients.