MEASURING DELIVERED DOSE OF DIALYSIS : ACHIEVING DELIVERED KT/V >1.2

Introduction:

Delivering adequate dialysis to each and every patient for every dialysis session is the goal for all nephrologists. Usually Urea reduction ratio and KT/V urea are  used for monitoring. The typical frequency of monitoring is monthly and it may not reflect delivered dialysis dose on other days. KT/V measured by Online clearance monitor (OCM) provides an important method that can be done for each treatment for every patient and reviewed with electronic data capture.Our Aim was to compare the accuracy of KT/V(OCM) with KT/V Urea by urea kinetic modelling(UKM) , to assess ability to capture KT/V OCM for all patients for all treatments, to assess percentage of dialysis session with delivered KT/V > 1.2.

Methods:

Patient aged more than 18 years who are on maintenance hemodialysis for at least one month after initiation and who get pre and post dialysis blood samples at our center were selected. Data was collected from November 2023 to August 2024. KT/V(OCM) was measured on 4008S Fresenius hemodialysis machines and single pool KT/V (UKM) by urea kinetic modelling using second generation Daugirdas equation. Data on duration of dialysis treatment, ultrafiltration volume and KT/V (OCM) was retrieved from Therapy data management system (TDMS Fresenius) and post hemodialysis weight recorded manually into TDMS. Analysis of correlation of both these methods of determining KT/V was done. Also evaluated percentage of HD treatments for which KT/V was captured in our outpatient dialysis and number of treatment with KT/V > 1.2.

Results:

Total Number of sessions of dialysis in the study period was 8931 and 93 % of all sessions ( 8278) were captured .Average Time of Dialysis treatment was 223 minutes. KT/V (OCM) mean was 1.33±0.22 and Kt/V UKM was 1.34±0.43. KT/V OCM and KT/V UKM are highly correlated with a R Value 0f  0.68 and p<0.001. Although Only 3 patients had Urea reduction ratio less 65%. KT/V less than 1.2 was in 41% by OCM and 36% by UKM .Figure 1 & Table 1 shows correlation between the two methods.

Conclusions:

This study shows that KT/V (OCM) can be used as a surrogate marker for KT/V  by Urea kinetic modelling. KT/V (OCM) can be captured routinely for all patients for all sessions and majority of patients  can achieve a KT/V > 1.2. Review of those with KT/V OCM <1.2 and adjustment in their access, dialyzer or dialysis treatment time can ensure the nephrologists goal of  achieving adequate dialysis for each patient every time.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.