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Kt/V: patients do not get what the physician prescribes
J M LeFebvre1, E Spanner, A P Heidenheim
1Department of Medicine, Victoria Hospital, London, Ontario, Canada.
ASAIO Transactions
|July 1, 1991
Summary
Dialysis patients often do not achieve their prescribed dialysis dose (Kt/V). CompuMod and Daugirdas methods best estimate Kt/V, while Jindal-Goldstein overestimates it, highlighting the need for accurate urea kinetic modeling.
Area of Science:
- Nephrology
- Biomedical Engineering
Background:
- Monthly urea kinetic modeling (UKM) is crucial for ensuring adequate dialysis dose (Kt/V ≥ 1) and protein catabolic rate (PCR ≥ 0.8).
- Accurate assessment of dialysis adequacy is essential for optimizing patient outcomes in hemodialysis.
Purpose of the Study:
- To evaluate the frequency of achieving prescribed dialysis dose (Kt/V) using three different UKM methods: CompuMod, Jindal-Goldstein, and Daugirdas.
- To compare the accuracy of these methods in estimating delivered Kt/V against the prescribed target.
Main Methods:
- Ten hemodialysis patients were monitored over one month, undergoing 120 dialyses.
- Kt/V values were calculated using the CompuMod, Jindal-Goldstein, and Daugirdas methods and compared to the prescribed values.
- Statistical analysis was performed to determine significant differences between methods and the percentage of dialyses achieving the target Kt/V (p ± 5%).
Main Results:
- Mean Kt/V values varied by method: Prescription (1.54), Service (1.40), CompuMod (1.33), Jindal-Goldstein (1.55), and Daugirdas (1.33).
- CompuMod and Daugirdas methods yielded significantly lower Kt/V estimates (p < 0.001) compared to the prescribed value.
- Only 12.4-14.3% of dialyses achieved the target Kt/V within the ± 5% range across the three methods.
Conclusions:
- Hemodialysis patients frequently fail to achieve their prescribed dialysis dose (Kt/V).
- The Jindal-Goldstein method tends to overestimate delivered Kt/V, while CompuMod and Daugirdas provide more accurate, albeit lower, estimates.
- Service Kt/V is not a reliable parameter for dialysis prescription, and frequent, accurate UKM is essential, with an online urea monitor being an ideal future solution.