Classic and online methods for Kt/V measurement: comparison and reliability
Abstract
Aim: to compare the results of the delivered dialysis dose assessment by classical biochemical method and by on-line spectrophotometry of spent dialysate, to analyze the factors able to influence on-line method accuracy. Method: During a yearlong study in a single dialysis center in 143 patients the 1001 parallel Kt/V assessments by spectrophotometry with Ademia option (Dialog Plus, BBraun) - UV-Kt/V and by Daugirdas-II formula with calculation of Kt/V as reference. Results: In the whole group the mean UV-Kt/V was 1.49±0.21 and eKt/V was 1.40±0.19 (p<0.001). The correlation between two methods was high - r=0.868 (p<0.001). Systematic error of spectrophotometric method was +5.7% (+0.083 unit of Kt/V), a random error - 7.3% (±0.106). The linear function (eKt/V)=0.819×(UV-Kt/V)+0,194, R2=0.754 gave the best fit for describing relation between the results. The deviation was not related to Kt/V value, ultrafiltration volume, baseline urea level, urea reduction ratio as well as to age, gender, duration of renal replacement therapy and diagnosis. The discrepancy was slightly higher (in favor UV-Kt/V) at low and high extracorporeal blood flow compared to its mean value (311 ml/min). At 87 of 12 381 dialysis sessions (0.7%) we registered deformed graph of on-line Kt/V related to impairment of blood intake to extracorporeal (13% of such cases), hypotension (11%), access recirculation (3%). Conclusion: Determination of Kt/V on-line by spectrophotometry of spent dialysate is in good consistence with classic blood-side method. It enables the monitoring of delivered dialysis dose at each session and helps searching the reason for discrepancy. The outlook for increasing method accuracy is related with the improvement of the algorithms of spectrophotometry data processing.
About the Authors
G. A. Zemchenkov
B. Braun Avitum Russland Clinics
Russian Federation
Russian Federation
A. B. Sabodash
B. Braun Avitum Russland Clinics; I.P. Pavlov First Saint-Petersburg State medical university
Russian Federation
Russian Federation
N. S. Kazantseva
B. Braun Avitum Russland Clinics
Russian Federation
Russian Federation
O. V. Makarova
B. Braun Avitum Russland Clinics
Russian Federation
Russian Federation
A. Yu. Zemchenkov
B. Braun Avitum Russland Clinics; I.P. Pavlov First Saint-Petersburg State medical university; I.I. Mechnikov North-West State medical university
Russian Federation
Russian Federation
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For citations:
Zemchenkov G.A., Sabodash A.B., Kazantseva N.S., Makarova O.V., Zemchenkov A.Yu. Classic and online methods for Kt/V measurement: comparison and reliability. Nephrology and Dialysis. 2015;17(2):173-184. (In Russ.)
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