Urea Kinetics and Clinical Evaluation of the Haemodialysis Patient

Urea kinetic modelling (UKM) was performed on 62 patients in a haemodialysis unit not normally using kinetic methods. Without knowledge of the results, four nephrologists, four nurses and the patients themselves evaluated adequacy of dialysis (eAD) and daily protein intake (eDPI). Thirty-two patient...

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Bibliographic Details
Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 1990, Vol.5 (5), p.347-351
Main Authors: Buur, T., Timpka, T., Lundberg, M.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Computer
Computerized, statistical medical data processing and models in biomedicine
Decision-making
Dietary Proteins - administration & dosage
Female
Haemodialysis
Humans
Male
Medical management aid. Diagnosis aid
Medical sciences
Middle Aged
Models, Biological
Practice research
Renal Dialysis
Urea - pharmacokinetics
Urea kinetic modelling
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Summary:Urea kinetic modelling (UKM) was performed on 62 patients in a haemodialysis unit not normally using kinetic methods. Without knowledge of the results, four nephrologists, four nurses and the patients themselves evaluated adequacy of dialysis (eAD) and daily protein intake (eDPI). Thirty-two patients had Kt/V < 1.0, and 17 patients had Kt/V < 0.9. Estimated improvement of the efficacy of treatment after the intervention of a physician was minor. Seven patients had a protein catabolic rate (pcr) at less than 0.8 g/kg per day. On average physicians identified five of these. Both nurses and doctors exhibited highly significant correlations between Kt/V and eAD, and between pcr and eDPI, but the correlation coefficients were generally modest (typically below 0.4). When patients evaluated themselves, no significant correlations were found. Examined individually, all four physicians' decisions about eAD correlated better with modelgenerated decisions than with eAD stated by their colleagues. It is concluded that UKM should be used to secure adequate and more uniform treatment prescription. There is no ‘clinical standard’ competing with UKM. Nurses make satisfactory evaluations compared to doctors, but the patients are unable to assess the adequacy of their dialysis or diet.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/5.5.347