TY - JOUR
T1 - Agreement between different parameters of dialysis dose in achieving treatment targets: results from the NECOSAD study
AU - Moret, Karin E.
AU - Grootendorst, Diana C.
AU - Dekker, Friedo W.
AU - Boeschoten, Elizabeth W.
AU - Krediet, Raymond T.
AU - Houterman, Saskia
AU - Beerenhout, Charles H.
AU - Kooman, Jeroen P.
AU - AUTHOR GROUP
AU - Apperloo, A. J.
AU - Bijlsma, J. A.
AU - Boekhout, M.
AU - Boer, W. H.
AU - van der Boog, P. J. M.
AU - Büller, H. R.
AU - van Buren, M.
AU - de Charro, F. Th
AU - Doorenbos, C. J.
AU - van den Dorpel, M. A.
AU - van Es, A.
AU - Fagel, W. J.
AU - Feith, G. W.
AU - de Fijter, C. W. H.
AU - Frenken, L. A. M.
AU - van Geelen, J. A. C. A.
AU - Gerlag, P. G. G.
AU - Gorgels, J. P. M. C.
AU - Grave, W.
AU - Huisman, R. M.
AU - Jager, K. J.
AU - Jie, K.
AU - Koning-Mulder, W. A. H.
AU - Koolen, M. I.
AU - Kremer Hovinga, T. K.
AU - Lavrijssen, A. T. J.
AU - Luik, A. J.
AU - van der Meulen, J.
AU - Parlevliet, K. J.
AU - Raasveld, M. H. M.
AU - van der Sande, F. M.
AU - Schonck, M. J. M.
AU - Schuurmans, M. M. J.
AU - Siegert, C. E. H.
AU - Stegeman, C. A.
AU - Stevens, P.
AU - Thijssen, J. G. P.
AU - Valentijn, R. M.
AU - Vastenburg, G. H.
AU - Verburgh, C. A.
AU - Vincent, H. H.
AU - Vos, P. F.
PY - 2012
Y1 - 2012
N2 - Background. The recommended parameter of dialysis dose differs between K-DOQI and the European Best Practice Guidelines. It is not well known to what extent an agreement exists between the different parameters, nor if target and delivered dialysis dose are prescribed according to the urea reduction rate (URR), single-pool Kt/V(spKt/V) or equilibrated double-pool Kt/V (eKt/V) and which parameter is most strongly related to mortality. Methods. In 830 haemodialysis patients from the NECO-SAD cohort URR, spKt/V and eKt/V were calculated and compared according to a classification regarding the recommended treatment targets (70%, 1.4 and 1.2, respectively) as well as minimum delivered dialysis dose (65%, 1.2 and 1.05, respectively). Moreover, the relation between treatment dose and survival was assessed using Cox regression analysis. Results. A spKt/V of >= 1.4 and URR >= 70% corresponded with eKt/V >= 1.20 (as reference method) in, respectively, 98.0 and 90.6% of patients. spKt/V of >= 1.2 and URR >= 65% corresponded with eKt/V >= 1.05 in, respectively, 95.5 and 91.2% of patients. Deviations from the reference method were significantly related to differences in urea distribution volume (spKt/V), treatment time (URR) and ultrafiltration volume (URR). The adjusted HR (95% CI) was 0.98 (0.96, 0.99) for URR, 0.51 (0.31, 0.84) for spKt/V and 0.46 (0.30, 0.80) for the eKt/V. Conclusion. The use of URR leads to larger disagreement with the reference method (eKt/V) treatment target as compared to spKt/V. Low urea distribution volume, short treatment time and low ultrafiltration volumes are predictive parameters for overestimation of dialysis dose when utilizing the alternative methods spKt/V and URR instead of eKt/V. Delivered eKt/V, spKt/V and URR were all positively related to survival
AB - Background. The recommended parameter of dialysis dose differs between K-DOQI and the European Best Practice Guidelines. It is not well known to what extent an agreement exists between the different parameters, nor if target and delivered dialysis dose are prescribed according to the urea reduction rate (URR), single-pool Kt/V(spKt/V) or equilibrated double-pool Kt/V (eKt/V) and which parameter is most strongly related to mortality. Methods. In 830 haemodialysis patients from the NECO-SAD cohort URR, spKt/V and eKt/V were calculated and compared according to a classification regarding the recommended treatment targets (70%, 1.4 and 1.2, respectively) as well as minimum delivered dialysis dose (65%, 1.2 and 1.05, respectively). Moreover, the relation between treatment dose and survival was assessed using Cox regression analysis. Results. A spKt/V of >= 1.4 and URR >= 70% corresponded with eKt/V >= 1.20 (as reference method) in, respectively, 98.0 and 90.6% of patients. spKt/V of >= 1.2 and URR >= 65% corresponded with eKt/V >= 1.05 in, respectively, 95.5 and 91.2% of patients. Deviations from the reference method were significantly related to differences in urea distribution volume (spKt/V), treatment time (URR) and ultrafiltration volume (URR). The adjusted HR (95% CI) was 0.98 (0.96, 0.99) for URR, 0.51 (0.31, 0.84) for spKt/V and 0.46 (0.30, 0.80) for the eKt/V. Conclusion. The use of URR leads to larger disagreement with the reference method (eKt/V) treatment target as compared to spKt/V. Low urea distribution volume, short treatment time and low ultrafiltration volumes are predictive parameters for overestimation of dialysis dose when utilizing the alternative methods spKt/V and URR instead of eKt/V. Delivered eKt/V, spKt/V and URR were all positively related to survival
U2 - https://doi.org/10.1093/ndt/gfr396
DO - https://doi.org/10.1093/ndt/gfr396
M3 - Article
C2 - 21817058
SN - 0931-0509
VL - 27
SP - 1145
EP - 1152
JO - Nephrology, dialysis, transplantation
JF - Nephrology, dialysis, transplantation
IS - 3
ER -