Personal viewpoint: Limiting maximum ultrafiltration rate as a potential new measure of dialysis adequacy

Hemodialysis International
John W M Agar

Abstract

While the solute clearance marker (Kt/Vurea ) is widely used, no effective marker for volume management exists. Two principles apply to acute volume change in hemodialysis: (1) the plasma refill rate, the maximum rate the extracellular fluid can replace a contracting intravascular volume (±5 mL/kg/hour) and (2) the rate of intravascular volume contraction where coronary hypoperfusion, myocardial stun, and vascular risk escalates (observed at ≥10 mL/kg/hour). In extended hour and higher frequency hemodialysis, intravascular contraction rates are usually equilibrated by the plasma refill rate, but in "conventional" in-center hemodialysis, volume contraction rates commonly exceed the capabilities of the plasma refill rate, resulting in inevitable hypovolemia. To minimize cardiovascular risk, fluid removal rates should ideally be ≤10 mL/kg/hour, acknowledging that this may be challenging in the in-center setting. Two options exist to limit volume removal to >10 mL/kg/hour: restricting interdialytic weight gain (always conflict-fraught, often unachievable) or extending sessional duration to allow additional removal time. Just as Kt/Vurea quantifies solute removal, a simple-to-apply rate variable should also apply for volume removal....Continue Reading

References

Sep 1, 1985·Kidney International·F A Gotch, J A Sargent
May 1, 1981·Hypertension·M ChaignonS Nakamoto
Jan 24, 2004·News in Physiological Sciences : an International Journal of Physiology Produced Jointly by the International Union of Physiological Sciences and the American Physiological Society·Michael J McKinley, Alan Kim Johnson
Aug 21, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Nicholas M SelbyChristopher W McIntyre
Sep 25, 2007·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Ezio MovilliGiovanni Cancarini
Nov 16, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Christopher W McIntyrePaolo G Camici
Apr 10, 2009·Clinical Journal of the American Society of Nephrology : CJASN·James O BurtonChristopher W McIntyre
May 29, 2010·Clinical Journal of the American Society of Nephrology : CJASN·Rajiv Agarwal, Matthew R Weir
Oct 12, 2010·Kidney International·Jennifer E FlytheSteven M Brunelli
Nov 3, 2010·Seminars in Dialysis·Christopher W McIntyre
May 21, 2011·Clinical Journal of the American Society of Nephrology : CJASN·Helen J JefferiesChristopher W McIntyre
Feb 23, 2012·Seminars in Dialysis·Mohamed Tarek Eldehni, Christopher W McIntyre
Mar 16, 2013·Clinical Journal of the American Society of Nephrology : CJASN·Jennifer E FlytheSteven M Brunelli
Feb 18, 2014·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Hugh C RaynerBruce M Robinson

❮ Previous
Next ❯

Citations

Aug 31, 2016·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Magdalene M AssimonJennifer E Flythe
Oct 25, 2016·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Allan J Collins, Christopher T Chan
May 5, 2017·Journal of Renal Care
Feb 16, 2018·Journal of Clinical Nursing·Ulrich SteinwandelJohan Rosman
Jun 24, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Jennifer E FlytheLily Wang
Oct 18, 2016·Current Opinion in Nephrology and Hypertension·Ambreen GulPhilip Zager
Mar 13, 2020·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Jule PinterBernard Canaud
Sep 2, 2020·Journal of Nephrology·Giacomo DeferrariEdoardo La Porta
Aug 15, 2017·Current Heart Failure Reports·Jason A Chou, Kamyar Kalantar-Zadeh

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.

Related Papers

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
Ajay P Sharma, Peter G Blake
Acta Medica Croatica : C̆asopis Hravatske Akademije Medicinskih Znanosti
Vedran KovacićDominka Dzanko
Clinical Journal of the American Society of Nephrology : CJASN
Jennifer E FlytheSteven M Brunelli
© 2021 Meta ULC. All rights reserved