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A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all. / El-Kateb, Sally; Sridharan, Sivakumar; Farrington, Ken; Fan, Stanley; Davenport, Andrew.

In: Kidney international, Vol. 90, No. 6, 31.12.2016, p. 1342-1347.

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El-Kateb, Sally ; Sridharan, Sivakumar ; Farrington, Ken ; Fan, Stanley ; Davenport, Andrew. / A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all. In: Kidney international. 2016 ; Vol. 90, No. 6. pp. 1342-1347.

Bibtex

@article{b8072f466746488b8d6527f79059f43e,
title = "A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all",
abstract = "Dialysis adequacy is traditionally based on urea clearance, adjusted for total body volume (Kt/Vurea), and clinical guidelines recommend a Kt/Vurea target for peritoneal dialysis. We wished to determine whether adjusting dialysis dose by resting and total energy expenditure would alter the delivered dialysis dose. The resting and total energy expenditures were determined by equations based on doubly labeled isotopic water studies and adjusted Kturea for resting energy expenditure and total energy expenditure in 148 peritoneal dialysis patients (mean age, 60.6 years; 97 male [65.5{\%}]; 54 diabetic [36.5{\%}]). The mean resting energy expenditure was 1534 kcal/d, and the total energy expenditure was 1974 kcal/day. Using a weekly target Kt/V of 1.7, Kt was calculated using V measured by bioimpedance and the significantly associated (r = 0.67) Watson equation for total body water. Adjusting Kt for resting energy expenditure showed a reduced delivered dialysis dose (ml/kcal per day) for women versus men (5.5 vs. 6.2), age under versus over 65 years (5.6 vs. 6.4), weight <65 versus >80 kg (5.8 vs. 6.1), low versus high comorbidity (5.9 vs. 6.2), all of which were significant. Adjusting for the total energy expenditure showed significantly reduced dosing for those employed versus not employed (4.3 vs. 4.8), a low versus high frailty score (4.5 vs. 5.0) and nondiabetic versus diabetic (4.6 vs. 4.9). Thus, the current paradigm for a single target Kt/Vurea for all peritoneal dialysis patients does not take into account energy expenditure and metabolic rate and may lead to lowered dialysis delivery for the younger, more active female patient.",
keywords = "Adult, Aged, Energy Metabolism, Female, Humans, Kidney Failure, Chronic, Male, Middle Aged, Peritoneal Dialysis, Journal Article",
author = "Sally El-Kateb and Sivakumar Sridharan and Ken Farrington and Stanley Fan and Andrew Davenport",
note = "Copyright {\circledC} 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.",
year = "2016",
month = "12",
day = "31",
doi = "10.1016/j.kint.2016.07.027",
language = "English",
volume = "90",
pages = "1342--1347",
journal = "Kidney international",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "6",

}

RIS

TY - JOUR

T1 - A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all

AU - El-Kateb, Sally

AU - Sridharan, Sivakumar

AU - Farrington, Ken

AU - Fan, Stanley

AU - Davenport, Andrew

N1 - Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

PY - 2016/12/31

Y1 - 2016/12/31

N2 - Dialysis adequacy is traditionally based on urea clearance, adjusted for total body volume (Kt/Vurea), and clinical guidelines recommend a Kt/Vurea target for peritoneal dialysis. We wished to determine whether adjusting dialysis dose by resting and total energy expenditure would alter the delivered dialysis dose. The resting and total energy expenditures were determined by equations based on doubly labeled isotopic water studies and adjusted Kturea for resting energy expenditure and total energy expenditure in 148 peritoneal dialysis patients (mean age, 60.6 years; 97 male [65.5%]; 54 diabetic [36.5%]). The mean resting energy expenditure was 1534 kcal/d, and the total energy expenditure was 1974 kcal/day. Using a weekly target Kt/V of 1.7, Kt was calculated using V measured by bioimpedance and the significantly associated (r = 0.67) Watson equation for total body water. Adjusting Kt for resting energy expenditure showed a reduced delivered dialysis dose (ml/kcal per day) for women versus men (5.5 vs. 6.2), age under versus over 65 years (5.6 vs. 6.4), weight <65 versus >80 kg (5.8 vs. 6.1), low versus high comorbidity (5.9 vs. 6.2), all of which were significant. Adjusting for the total energy expenditure showed significantly reduced dosing for those employed versus not employed (4.3 vs. 4.8), a low versus high frailty score (4.5 vs. 5.0) and nondiabetic versus diabetic (4.6 vs. 4.9). Thus, the current paradigm for a single target Kt/Vurea for all peritoneal dialysis patients does not take into account energy expenditure and metabolic rate and may lead to lowered dialysis delivery for the younger, more active female patient.

AB - Dialysis adequacy is traditionally based on urea clearance, adjusted for total body volume (Kt/Vurea), and clinical guidelines recommend a Kt/Vurea target for peritoneal dialysis. We wished to determine whether adjusting dialysis dose by resting and total energy expenditure would alter the delivered dialysis dose. The resting and total energy expenditures were determined by equations based on doubly labeled isotopic water studies and adjusted Kturea for resting energy expenditure and total energy expenditure in 148 peritoneal dialysis patients (mean age, 60.6 years; 97 male [65.5%]; 54 diabetic [36.5%]). The mean resting energy expenditure was 1534 kcal/d, and the total energy expenditure was 1974 kcal/day. Using a weekly target Kt/V of 1.7, Kt was calculated using V measured by bioimpedance and the significantly associated (r = 0.67) Watson equation for total body water. Adjusting Kt for resting energy expenditure showed a reduced delivered dialysis dose (ml/kcal per day) for women versus men (5.5 vs. 6.2), age under versus over 65 years (5.6 vs. 6.4), weight <65 versus >80 kg (5.8 vs. 6.1), low versus high comorbidity (5.9 vs. 6.2), all of which were significant. Adjusting for the total energy expenditure showed significantly reduced dosing for those employed versus not employed (4.3 vs. 4.8), a low versus high frailty score (4.5 vs. 5.0) and nondiabetic versus diabetic (4.6 vs. 4.9). Thus, the current paradigm for a single target Kt/Vurea for all peritoneal dialysis patients does not take into account energy expenditure and metabolic rate and may lead to lowered dialysis delivery for the younger, more active female patient.

KW - Adult

KW - Aged

KW - Energy Metabolism

KW - Female

KW - Humans

KW - Kidney Failure, Chronic

KW - Male

KW - Middle Aged

KW - Peritoneal Dialysis

KW - Journal Article

U2 - 10.1016/j.kint.2016.07.027

DO - 10.1016/j.kint.2016.07.027

M3 - Article

VL - 90

SP - 1342

EP - 1347

JO - Kidney international

JF - Kidney international

SN - 0085-2538

IS - 6

ER -