Urea kinetics and clinical evaluation of the haemodialysis patient

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
T BuurM Lundberg

Abstract

Urea kinetic modelling (UKM) was performed on 62 patients in a haemodialysis unit not normally using kinetic methods. Without knowledge of the results, four nephrologists, four nurses and the patients themselves evaluated adequacy of dialysis (eAD) and daily protein intake (eDPI). Thirty-two patients had Kt/V less than 1.0, and 17 patients had Kt/V less than 0.9. Estimated improvement of the efficacy of treatment after the intervention of a physician was minor. Seven patients had a protein catabolic rate (pcr) at less than 0.8 g/kg per day. On average physicians identified five of these. Both nurses and doctors exhibited highly significant correlations between Kt/V and eAD, and between pcr and eDPI, but the correlation coefficients were generally modest (typically below 0.4). When patients evaluated themselves, no significant correlations were found. Examined individually, all four physicians' decisions about eAD correlated better with model-generated decisions than with eAD stated by their colleagues. It is concluded that UKM should be used to secure adequate and more uniform treatment prescription. There is no 'clinical standard' competing with UKM. Nurses make satisfactory evaluations compared to doctors, but the patients ar...Continue Reading

Citations

Oct 1, 1994·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·T BuurJ T Brocklebank
Jul 1, 1992·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·J H EvansJ T Brocklebank
Jul 1, 1993·Postgraduate Medical Journal·K Farrington, P Sweny
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Feb 1, 1992·Clinical Physics and Physiological Measurement : an Official Journal of the Hospital Physicists' Association, Deutsche Gesellschaft Für Medizinische Physik and the European Federation of Organisations for Medical Physics·S W SmyeJ T Brocklebank
Dec 30, 1990·Klinische Wochenschrift·M SchmidliU Binswanger
Apr 9, 1999·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·H YounesC Rémésy

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