Reassessing hemodialysis adequacy in children: the case for more
- Atul K. Sharma
- Pediatric Nephrology
Two methods have been suggested by Daugirdas and Schneditz (the rate equation), and Smye for predicting true equilibrated Kt/V (eKt/V) without the need for obtaining a blood sample 60 min after hemodialysis (HD). We compared the accuracy of these two methods when applied to pediatric HD. Thirty-eight standard pediatric HD sessions in 15 patients, (6 male, 9 female), aged 14.5±3.3 years, were analyzed. Kt/V was calculated by formal variable-volume single-pool urea kinetic model with post-HD urea taken at the end of HD (single-pool Kt/V), and with equilibrated urea (Ceq) taken 60 min after the end of HD (eKt/V). eKt/V was predicted by the rate equation from single-pool Kt/V and by the Smye method from predicted Ceq. Mean values obtained by both the rate equation (1.44±0.32, P>0.05) and by the Smye method (1.47±0.36, P>0.05) were similar to eKt/V (1.42±0.30), but correlation between results from the rate equation and eKt/V (r=0.863) was higher than between those from the Smye method and eKt/V (r=0.654). Average absolute error of the rate equation in predicting eKt/V was 0.118±0.114 (median 0.095) Kt/V units and 8.53%±8.36% (median 6.29%), while for the Smye method it was significantly higher [0.221±0.180 (median 0.190) Kt/V units, P=0.001; 16.49%±15.98% (median 11.88%) P=0.004]. High correlation between eKt/V and results from the rate equation indicates that urea rebound (expressed as ΔKt/V) is a function of the rate of dialysis (K/V). To test this, we analyzed the relationship of K/V and other parameters (session duration, body mass index, ultrafiltration rate, blood flow, and urea distribution volume) with ΔKt/V. The only significant (P<0.01) and highest correlation (r=0.442) was found for K/V. We conclude that in children on chronic HD, the rate equation is a better predictor of eKt/V than the Smye method, and that HD efficiency is the strongest determinant of postdialysis urea rebound in children.