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Fractional urea clearance estimates using two anthropometric formulas in continuous peritoneal dialysis: sex, height,
A H Tzamaloukas1, N V Dombros, G H Murata
1Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, USA.
Objective:
To compare estimates of urea volume (V) and KT/V obtained by the Watson and Hume anthropometric formulas, and to identify the similarities and differences between these estimates.
Design:
Theoretical analysis applying wide variations in the determinants of anthropometric V (age, height, weight) in hypothetical women and men. Analysis of urea kinetic studies performed in patients on continuous peritoneal dialysis (CPD).
Setting:
Four dialysis units in Albuquerque, two in Athens, and two in Thessaloniki.
Participants:
Three hundred and two CPD patients who had 440 urea kinetic studies.
Intervention:
Standard urea clearance was performed by 24-hour collections of urine and drained dialysate followed by blood sampling. V was estimated by both the Watson and Hume formulas.
Main Outcome Measures:
Estimates of V and KT/V were compared separately in women and men by Student's t-test, linear regression, and limits of agreement (mean difference +/- 2 SD). The agreement of the KT/V estimates was also tested by the kappa ratio using a value of 1.70 weekly as the lowest acceptable K/TV.
Results:
The theoretical analysis indicated important disagreement only in extreme variations from the ordinary in height and, to a lesser extent, weight. Differences due to height variation were pronounced only in hypothetical women. CPD patient findings were as follows: in women, Watson V and weekly KT/V were 30.4 +/- 4.4 L and 2.10 +/- 0.61, respectively. Corresponding Hume estimates were 30.3 +/- 5.4 Land 2.1 2 +/- 0.66, respectively. Corresponding estimates for men were 40.5 +/- 5.7 L and 1 .92 +/- 0.57 (Watson) plus 41.4 +/- 5.6 L and 1.88 +/- 0.57 (Hume), respectively. By linear regression, KT/V(Hume) = -0.083 + 1.052 (KT/V(Watson)), r = 0.961 (women); and KT/V(Hume) = -0.026 +/- 0.992 (KT/V(Watson)), r = 0.985 (men). Limits of agreement were -1.41 L and 2.10 L for V, and -0.15 and 0.14 weekly for KT/V. In 94.3% of the cases, KT/V(Watson) and KT/V(Hume) agreed (both > 1 .70 or both < 1 .70 weekly). Kappa ratio was 0.875 (excellent agreement). The concordant and discordant groups differed in height and degree of obesity, in agreement with the theoretical analysis.
Conclusion:
The Watson and Hume formulas provide similar estimates of V and KT/V in CPD patients. Differences may be noted only if women's height or, to a lesser extent, both sexes' weight is at a great variance with the ordinary values.