Dialysis Centre SM2, Policoro, Italy.
Nephrology Department, Hospital Universitario de Navarra, Pamplona, Spain.
Nephrol Dial Transplant. 2024 Feb 28;39(3):445-452. doi: 10.1093/ndt/gfad212.
There is growing interest in home haemodialysis (HHD) performed with low-flow dialysate devices and variable treatment schedules. The target standard Kt/V (stdKt/V) should be 2.3 volumes/week, according to KDOQI guidelines (2015). The current formula for stdKt/V does not help prescribe the dialysis dose (eKt/V) and treatment frequency (TF). The aim of this study was to obtain a formula for stdKt/V that is able to define the minimum required values of eKt/V and TF to achieve the targeted stdKtV.
Thirty-eight prevalent patients on HHD were enrolled. A total of 231 clinical datasets were available for urea modelling using the Solute-Solver software (SS), recommended by KDOQI guidelines. A new formula (stdKt/V = a + b × Kru + c × eKt/V) was obtained from multivariable regression analysis of stdKt/V vs eKt/V and residual kidney urea clearance (Kru). The values of coefficients a, b and c depend on the treatment schedules and the day of the week of blood sampling for the kinetic study (labdayofwk) and then vary for each of their foreseen 62 combinations. For practical purposes, we used only seven combinations, assuming Monday as a labdayofwk for each of the most common schedules of the 7 days of the week.
The stdKt/V values obtained with SS were compared with the paired ones obtained with the formula. The mean ± standard deviation stdKt/V values obtained with SS and the formula were 3.043 ± 0.530 and 2.990 ± 0.553, respectively, with 95% confidence interval +0.15 to -0.26. A 'prescription graph' was built using the formula to draw lines expressing the relationship between Kru and required eKt/V for each TF. Using this graph, TF could have been reduced from the delivered 5.8 ± 0.8 to 4.8 ± 0.8 weekly sessions.
The new formula for stdKtV is reliable and can support clinicians to prescribe the dialysis dose and TF in patients undergoing HHD.
使用低流量透析液设备和可变治疗方案进行家庭血液透析（HHD）越来越受到关注。根据 KDOQI 指南（2015 年），目标标准 Kt/V（stdKt/V）应为 2.3 体积/周。目前的 stdKt/V 公式无助于规定透析剂量（eKt/V）和治疗频率（TF）。本研究旨在获得一个能够定义达到目标 stdKtV 所需的最低 eKt/V 和 TF 值的 stdKt/V 公式。
纳入 38 名接受 HHD 的患者。共有 231 例临床数据集可用于使用 KDOQI 指南推荐的 Solute-Solver 软件（SS）进行尿素建模。通过多变量回归分析 stdKt/V 与 eKt/V 和残余肾尿素清除率（Kru），从 SS 获得了一个新的公式（stdKt/V=a+b×Kru+c×eKt/V）。系数 a、b 和 c 的值取决于治疗方案和动力学研究的采血日（labdayofwk），然后因每个预期的 62 种组合而有所不同。出于实际目的，我们仅使用了七种组合，假设每周的星期一为 labdayofwk，适用于每周的七种最常见方案中的每一种。
用 SS 得到的 stdKt/V 值与用公式得到的配对值进行了比较。SS 和公式得到的平均标准偏差 stdKt/V 值分别为 3.043±0.530 和 2.990±0.553，95%置信区间为+0.15 至-0.26。使用该公式绘制了一条表示 Kru 与每个 TF 所需 eKt/V 之间关系的“处方图”。使用该图，TF 可以从每周 5.8±0.8 次减少到 4.8±0.8 次。
新的 stdKtV 公式可靠，可帮助临床医生为接受 HHD 的患者规定透析剂量和 TF。
