TY - JOUR
T1 - Scaling Hemodialysis Target Dose to Reflect Body Surface Area, Metabolic Activity, and Protein Catabolic Rate
T2 - A Prospective, Cross-sectional Study
AU - Sridharan, Sivakumar
AU - Vilar, Enric
AU - Davenport, Andrew
AU - Ashman, Neil
AU - Almond, Michael
AU - Banerjee, Anindya
AU - Roberts, Justin
AU - Farrington, Kenneth
N1 - This document is the Accepted Manuscript version of the following article: Sivakumar Sridharan, Enric Vilar, Andrew Davenport, Neil Ashman, Michael Almond, Anindya Banerjee, Justin Roberts and Ken Farrington, 'Scaling Hemodialysis Target Dose to Reflect Body Surface Area, Metabolic Activity, and Protein Catabolic Rate: A Prospective, Cross-sectional Study, American Journal of Kidney Diseases, Vol. 69 (3): 358-366, March 2017.
The version of record is available online at doi: https://doi.org/10.1053/j.ajkd.2016.07.025.
© 2016 by the National Kidney Foundation, Inc.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - BACKGROUND: Women and small men treated by hemodialysis (HD) have reduced survival. This may be due to use of total-body water (V) as the normalizing factor for dialysis dosing. In this study, we explored the equivalent dialysis dose that would be delivered using alternative scaling parameters matching the current recommended minimum Kt/V target of 1.2.STUDY DESIGN: Prospective cross-sectional study.SETTING & PARTICIPANTS: 1,500 HD patients on a thrice-weekly schedule, recruited across 5 different centers.PREDICTORS: Age, sex, weight, race/ethnicity, comorbid condition level, and employment status.OUTCOMES: Kt was estimated by multiplying V by 1.2. Kt/body surface area (BSA), Kt/resting energy expenditure (REE), Kt/total energy expenditure (TEE) and Kt/normalized protein catabolic rate (nPCR) equivalent to a target Kt/V of 1.2 were then estimated by dividing Kt by the respective parameters.MEASUREMENTS: Anthropometry, HD adequacy details, and BSA were obtained by standard procedures. REE was estimated using a novel validated equation. TEE was calculated from physical activity data obtained using the Recent Physical Activity Questionnaire. nPCR was estimated using a standard formula.RESULTS: Mean BSA was 1.87m(2); mean REE, 1,545kcal/d; mean TEE, 1,841kcal/d; and mean nPCR, 1.03g/kg/d. For Kt/V of 1.2, there was a wide range of equivalent doses expressed as Kt/BSA, Kt/REE, Kt/TEE, and Kt/nPCR. The mean equivalent dose was lower in women for all 4 parameters (P<0.001). Small men would also receive lower doses compared with larger men. Younger patients, those with low comorbidity, those employed, and those of South Asian race/ethnicity would receive significantly lower dialysis doses with current practice.LIMITATIONS: Cross-sectional study; physical activity data collected by an activity questionnaire.CONCLUSIONS: Current dosing practices may risk underdialysis in women, men of smaller body size, and specific subgroups of patients. Using BSA-, REE-, or TEE-based dialysis prescription would result in higher dose delivery in these patients.
AB - BACKGROUND: Women and small men treated by hemodialysis (HD) have reduced survival. This may be due to use of total-body water (V) as the normalizing factor for dialysis dosing. In this study, we explored the equivalent dialysis dose that would be delivered using alternative scaling parameters matching the current recommended minimum Kt/V target of 1.2.STUDY DESIGN: Prospective cross-sectional study.SETTING & PARTICIPANTS: 1,500 HD patients on a thrice-weekly schedule, recruited across 5 different centers.PREDICTORS: Age, sex, weight, race/ethnicity, comorbid condition level, and employment status.OUTCOMES: Kt was estimated by multiplying V by 1.2. Kt/body surface area (BSA), Kt/resting energy expenditure (REE), Kt/total energy expenditure (TEE) and Kt/normalized protein catabolic rate (nPCR) equivalent to a target Kt/V of 1.2 were then estimated by dividing Kt by the respective parameters.MEASUREMENTS: Anthropometry, HD adequacy details, and BSA were obtained by standard procedures. REE was estimated using a novel validated equation. TEE was calculated from physical activity data obtained using the Recent Physical Activity Questionnaire. nPCR was estimated using a standard formula.RESULTS: Mean BSA was 1.87m(2); mean REE, 1,545kcal/d; mean TEE, 1,841kcal/d; and mean nPCR, 1.03g/kg/d. For Kt/V of 1.2, there was a wide range of equivalent doses expressed as Kt/BSA, Kt/REE, Kt/TEE, and Kt/nPCR. The mean equivalent dose was lower in women for all 4 parameters (P<0.001). Small men would also receive lower doses compared with larger men. Younger patients, those with low comorbidity, those employed, and those of South Asian race/ethnicity would receive significantly lower dialysis doses with current practice.LIMITATIONS: Cross-sectional study; physical activity data collected by an activity questionnaire.CONCLUSIONS: Current dosing practices may risk underdialysis in women, men of smaller body size, and specific subgroups of patients. Using BSA-, REE-, or TEE-based dialysis prescription would result in higher dose delivery in these patients.
KW - Hemodialysis target dose
KW - dialysis dosing
KW - Kt/V
KW - metabolism
KW - energy expenditure
KW - dialysis adequacy
KW - body size
KW - physical activity
KW - sex differences
KW - end-stage renal disease (ESRD)
U2 - 10.1053/j.ajkd.2016.07.025
DO - 10.1053/j.ajkd.2016.07.025
M3 - Article
C2 - 27663037
SN - 0272-6386
VL - 69
SP - 358
EP - 366
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -