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Normalization of Dialysis Dose for Daily Dialysis
1Division of Nephrology, Department of Medicine, University of California, San Francisco, U.S.A.
Hemodialysis International. International Symposium on Home Hemodialysis
|April 29, 2017
Summary
The standard Kt/V (stdKt/V) accurately measures dialysis dose across different schedules, unlike equilibrated Kt/V (eKtV) or equivalent renal clearance (EKR). EKR does not account for dialysis frequency, making it unsuitable for normalizing hemodialysis dose.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Dialysis Efficacy Measurement
Background:
- Equilibrated Kt/V (eKtV) is a common measure of hemodialysis (HD) intensity but is not suitable for all dialysis schedules.
- Standard Kt/V (stdKt/V) was developed to address limitations of eKtV, accurately normalizing dialysis dose across different frequencies.
- Equivalent Renal Clearance (EKR) has been proposed but is mathematically equivalent to time-averaged clearance, failing to account for treatment frequency.
Purpose of the Study:
- To evaluate the suitability of Equivalent Renal Clearance (EKR) as a parameter for normalizing dialysis dose across varying hemodialysis frequencies.
- To compare the efficacy of different dialysis dose metrics, including eKtV, stdKt/V, and EKR, particularly in the context of daily dialysis.
Main Methods:
- Analysis of existing data on daily dialysis treatments.
- Mathematical consideration of EKR as a measure of dialysis clearance.
- Comparison of EKR calculations with summed eKtV values for daily dialysis sessions.
Main Results:
- Mathematical analysis indicates EKR represents time-averaged clearance.
- Calculated EKR for daily dialysis was found to be identical to the sum of individual eKtV values.
- This finding demonstrates that EKR does not adequately reflect the impact of dialysis frequency on overall therapeutic dose.
Conclusions:
- Equivalent Renal Clearance (EKR) is not a suitable parameter for normalizing dialysis dose in hemodialysis.
- EKR fails to account for the crucial effect of dialysis frequency, unlike stdKt/V.
- Standard Kt/V (stdKt/V) remains the preferred metric for accurately assessing and normalizing dialysis dose across diverse treatment schedules.
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