Use of ionic dialysance to calculate Kt/V in pediatric hemodialysis

作者：Marsenic Olivera^*; Booker Kristi; Studnicka Kathleen; Wilson Donna; Beck Ann; Swanson Tiffany; Henry Dwayne; Turman Martin

来源：Hemodialysis International, 2011, 15: S2-S8.

DOI：10.1111/j.1542-4758.2011.00595.x

• Pediatric hemodialysis
• ionic dialysance
• Kt/V
• online clearance
• urea distribution volume

Online clearance (OLC) monitor measures conductivity difference between dialysate entering and leaving the dialyser. Derived ionic dialysance (ID) represents effective urea clearance from which Kt/V is calculated, allowing Kt/V monitoring at every treatment without blood sampling. We tested ID accuracy in children and provide recommendations for its use. Using Fresenius machines 2008 K with built-in OLC monitors, we studied 45 hemodialysis (HD) sessions and 168 calculated Kt/V results in 11 patients. Urea distribution volume (V), needed to calculate Kt/V from ID, was estimated using three methods: Mellits and Cheek (MC), KDOQI recommended total body water nomograms (TBWN) and OLC-derived independent from tested HD sessions. Reference spKt/V from pre-and post-HD BUN (Daugirdas) was compared with Kt/V calculated from ID using three different estimated V's. ID was accurate in calculating Kt/V in children when V derived from OLC was used (P = 0.42), with absolute error 0.14 +/- 0.12. If TBWN-derived V was used, Kt/V was consistently underestimated by 0.32 +/- 0.22. TBWN-derived V can still be recommended for use with OLC for monitoring trend in Kt/V, if underestimation of spKt/V of average 0.3 is accounted for. MC-derived V results in even greater underestimation of spKt/V and therefore cannot be recommended for use with OLC.

• 出版日期2011-10