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Unlike Kt, high Kt/V is associated with greater mortality: The importance of low V

Rafael Pérez-García1, Maite Jaldo1, Roberto Alcázar1

  • 1Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España.

Nefrologia
|August 5, 2018
PubMed

Insights

Kt/V is not a reliable measure of haemodialysis dose in patients with low body water. Lean mass and serum albumin better predict mortality risk than Kt/V.

Area of Science:

  • Nephrology
  • Dialysis Medicine
  • Clinical Nutrition

Background:

  • Kt/V has historically served as a benchmark for hemodialysis adequacy.
  • Previous studies suggested improved patient survival with higher Kt/V targets.
  • The HEMO study indicated no definitive link between Kt/V and mortality, prompting re-evaluation.

Purpose of the Study:

  • To investigate the relationship between mortality and hemodialysis dose metrics (Kt/V, Kt).
  • To assess the influence of body water content (V) and lean body mass on this relationship.
  • To determine if V confounds the association between Kt/V and mortality.

Main Methods:

  • A cohort of 127 prevalent hemodialysis patients was followed for 36 months.
  • Kt/V, Kt, and Kt/BSA were calculated using ionic dialysance and bioimpedance data.
  • Nutritional parameters, including lean mass index (LMI) and serum albumin, were assessed.

Main Results:

  • Higher Kt/V values correlated with worse survival rates, often linked to lower V and poorer nutrition.
  • Kt/V was found to be less reliable in patients with reduced body water.
  • Lean mass index and serum albumin independently predicted mortality risk and were lower in patients with higher Kt/V and lower V.

Conclusions:

  • Kt/V is not a suitable measure for dialysis dose in patients with low or reduced body water.
  • Kt or Kt/BSA are proposed as more reliable alternatives for assessing hemodialysis adequacy.
  • Nutritional status, particularly lean mass, is a critical factor in predicting mortality in dialysis patients.
Abstract

Keywords:
Agua corporal totalHaemodialysisHemodiálisisKtKt/VMortalidadMortalityNutriciónNutritionTotal body water

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