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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Assessing the adequacy of dialysis
Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association
|January 1, 1981
Summary
Reducing dialysis time in chronic renal failure patients worsened objective brain function measures, indicating that a minimum clearance level is crucial for adequate dialysis and preventing uremia.
Area of Science:
- Nephrology
- Neuroscience
- Uremia Research
Background:
- Objective measures of brain function (EEG, cognitive tests) previously identified clinical differences in chronic renal failure patients.
- These measures can objectively assess the neurobehavioral syndrome of clinical uremia.
Purpose of the Study:
- To determine if standard thrice-weekly dialysis time could be reduced in chronic renal failure patients without inducing clinical uremia.
- To establish a minimum level of adequate dialysis using urea clearance parameters.
Main Methods:
- A prospective experiment involving 10 patients with chronic renal failure.
- Three periods: 3-month control (C1), 6-month experimental (E) with reduced dialysis, and 3-6 month control (C2).
- Measures included quantified electroencephalogram (EEG), choice reaction time (CRT), continuous memory test (CMT), and clinical-symptom/self-evaluation questionnaire (CSE).
Main Results:
- Reducing dialysis clearance to 50-80% of the control level (3000ml/wk/L) worsened all objective measures: EEG (54%), CRT (2.5%), CMT (21%), and CSE (11%).
- Blood urea nitrogen (BUN) levels rose slightly, and urea generation rates fell.
- Patients reported feeling better despite recording more severe symptoms on the CSE questionnaire.
Conclusions:
- A total renal (Kr) plus dialyzer (Kd) urea clearance of 3000ml/wk/L approximates a minimum level for adequate dialysis.
- Objective neurobehavioral measures effectively detect inadequate dialysis and the onset of clinical uremia.
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