The mortality and morbidity of hemodialysis patients is to a large extent determined by demographics and by existing comorbidities but it is obvious that variations in dialysis dose have substancial effects. Using eKt/V 1.2 monthly comparisons are recommended by European guidelines, but they assume that dose is maintained during all monthly sessions.
Because of dilysis related problems like hypotension, reduction of blood flow, dialysis time, microclotting of the dialyzer, and vascular access problems the delivered dose may vary from session to session. New developed devices based on online conductivity clearance reflects the electrolites clearance and thus of urea.
The aim of this prospective study is show the variability of dialysis dose. 24 anuric pts were studied during 3 months, 20.8% were diabetics, mean age 64.7± 18.2 yo, 16% females.
Access blood were AVFi and the effective dialysed blood flow was set at 350 ml/min, with recirculation <5% . BMI 25.4 ± 3.8 kg/m2, body weight 69.7 ± 12 kg.
All pts were dialysed thrice weekly, 245 ± 21 min, with dialysis machine 4008H( Fresenius Medical Care) equiped with OCM monitor, and the hollow fibre high-flux polysulfone membrane (HF-80 S 1.8 m2) and helixone (Fx-60s, 1.6 m2). OCM was validate for our population and reported in other abcstract (r2= 0.96, p<0.001).
Dialysate flow was maintained at 500 ml/min, with standard dialysate liquid. Each patient was subjected to OCM on regular sessions during 3 months and blood Kt/V samples were taken on middweek day, once a month.
Data were processed and statistically analyzed with SPSS 11.0 software package. Kt/v- OCM relation to other baseline characteristics was assessed by using contingency tables, t-tests, analysis of variance and linear regression, as appropiate. All the test were performed for a 0.05 significance level.
The conductivity-based OCM provides an accurate tool to monitor the dose and control of each hemodiálisis session and adds to the efficiency of current dialysis adequacy monitoring.
OCM device requires little maintenance and not extra effort is needed. Monthly Kt/v does not reflect the variability of each session. Further studies are necessary to evaluate its influence on morbidity and mortality.
