Hemodialysis adequacy

Fluorescence detection at 284/310 nm (extinction/ emission wavelengths) leads to a detection limit of 1.3 mmol/L (0.14 mg/mL for / -cresol). Identification of phenol and /7-cresol may be confirmed by liquid chroma- tography/mass spectrometry. Because HPLC methods require only simple extraction, e.g., by ethyl acetate, and do not require further steps such as derivatization, they j are simple and rapid compared with gas chromatography or gas chromatography/mass spectrometry. Such methods I are useful for monitoring serum phenols in dialyzed patients as an index of hemodialysis adequacy. How- ever, the separation of the three isomers of cresol can only be performed by adding 3-cyclodextrin to the c liquid phase. q... 

The Kt/Vand urea reduction ratio are the most commonly used indicators for hemodialysis adequacy. The National Kidney Foundation s Kidney Disease Outcomes Quality Initiative has set a goal /Cf/Vof greater than 1.2 and a goal urea reduction ratio of greater than 65%. 

National Kidney Foundation. NKF-K/DOQI clinical practice guidelines for hemodialysis adequacy update 2000. Am J Kidney Dis 2001 37 S7-S64. 

National Kidney Foundation KDOQI Clinical practice guidelines and clinical practice recommendations for 2006 updates hemodialysis adequacy, peritoneal dialysis adequacy and vascular access. Am J Kidney Dis 2006 48(suppl) Sl S322. 

Hemodialysis adequacy depends - among other factors - on the effective blood flow through the dialyzer. The blood is pumped to and from the VA through dialysis needles smaller needles have a larger flow resistance that decrease delivered Qb (table 2). 

NKF KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 2006 48 S1-S322. 

NKF-K/DOQl (2001). NKF-K/DOQl clinical practice guidelines for hemodialysis adequacy Update 2000. Am. J. Kidney Dis. 37, S7. 

Urea Pharmacokinetics. Pharmacokinetics summarizes the relationships between solute generation, solute removal, and concentration in a patient s blood stream. In the context of hemodialysis, this analysis is most readily appHed to urea, which has, as a consequence, become a surrogate for other uremic toxins in the quantitation of therapy and in attempts to describe its adequacy. In the simplest case, a patient is assumed to have no residual renal function. Urea is generated from the breakdown of dietary protein, accumulates in a single pool equivalent to the patient s fluid volume, and is removed uniformly from that pool during hemodialysis. A mass balance around the patient yields the following differential equation ... 

Unfortunately, it is easier to describe inadequate PD than it is to provide a universally accepted definition of adequate PD. True PD adequacy requires the identification of an optimal dialysis dose that will result in favorable long-term outcomes, such as survival and quality of life. Compared to hemodialysis, which is used by a much larger patient population, there are few data available regarding the optimal dose of dialysis in PD. As a result, much of the work in this area has focused on establishing the minimum acceptable PD... 

Miller PE, Tolwani A, Luscy CP, Deierhoi MH, Bailey R, Redden DT, Allon M Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 1999 56 275-280. 

Ariano, R. E., Fine, A., Sitar, D. S., Rexrode, S., and Zelenitsky, S. A. (2005). Adequacy of a vancomycin dosing regimen in patients receiving high-flux hemodialysis. Am. J. Kidney Dis. 46, 681. 

Keshaviah PR, Nolph KD, Van Stone JC.1989. The peak concentration hypothesis A urea kinetic approach to comparing the adequacy of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis. 

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