Non-invasive monitoring of effective dialysis dose delivered to the haemodialysis patient |
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Authors: | Petitclerc, T. Bene, B. Jacobs, C. Jaudon, M. C. Goux, N. |
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Affiliation: | 1Department of Nephrology CHU Pitié-Salpétrière, Paris 2Department of Biophysics CHU Pitié-Salpétrière, Paris 3Laboratory of Biochemistry CHU Pitié-Salpétrière, Paris 4Hospal R&D Int Meyzieu, France |
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Abstract: | Assessment of normalized dialysis dose Kt/V actually deliveredto the patient carries the drawback of requiring several bloodor dialysate samplings and urea concentration measurements.In order to easily quantify Kt/V, we validate here the routineimplementation of an original technique for the non-invasive,on-line, and fully automatic estimation of total mean urea clearance.This estimation is obtained from the measurement by a conductivitymethod of the effective ionic dialysance DR, which is the dialysanceof electrolytes taking into account ultrafiltration and recirculation. The observed increase in DR with ultrafiltration rate and decreasein DR with elevation of access recirculation ratio show thatthe estimation of DR is affected by ultrafiltration and recirculationin a consistant manner. The mean value Keff of ionic dialysanceDR was compared with the value Kdc of effective urea clearanceobtained by dialysate collection during 12 haemodialysis sessions.The similarity (magnitude of variation 5%) between the ionicdialysance Keff and the effective urea clearance Kdc supportsthe validity of the equivalence between the transfer characteristicsof electrolytes and urea through the dialyser membrane. Givenan estimate of the urea distribution volume V, this estimationof effective urea clearance by ionic dialysance measurementallows an on-line estimation of the normalized dialysis doseKt/V actually delivered to the patient. |
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Keywords: | adequacy of dialysis conductivity modelling haemodialysis Kt/V index non-invasive monitoring |
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