The Problem with Kt/V: Dialysis Dose should be Normalized to Metabolic Rate not Volume
- 22 January 2007
- journal article
- Published by Wiley in Seminars in Dialysis
- Vol. 20 (1), 12-15
- https://doi.org/10.1111/j.1525-139x.2007.00232.x
Abstract
Current estimates of hemodialysis adequacy are based on calculations of small solute clearance or changes in online measurements of ionic conductance. A minimum target value of the widely used, dimensionless parameter, Kt/V(urea) has been adopted nationally and internationally to represent appropriate dialysis delivery. Based on the principles of allometry, which permit the calculation of scaling equations between the mass of an organism and other parameters, we propose that dialysis dose should be normalized to waste product generation (estimated by metabolic rate). The allometric equations predict a nonlinear correlation between body mass and dialysis dose, such that smaller individuals require proportionately ''more'' dialysis than larger persons. The argument we present is congruent with outcome data as it relates to sex, race, and body size, as well as supportive of studies suggesting that certain groups (e.g., pregnant women, critically ill patients, diabetics) require greater dialysis delivery than the hemodialysis population in general.Keywords
This publication has 25 references indexed in Scilit:
- Evaluating a new method to judge dialysis treatment using online measurements of ionic clearanceKidney International, 2006
- The online measurement of hemodialysis dose (Kt): Clinical outcome as a function of body surface areaKidney International, 2005
- Dialysis dose and the effect of gender and body size on outcome in the HEMO StudyKidney International, 2004
- Estimation of daily energy needs with the FAO/WHO/UNU 1985 procedures in adults: comparison to whole-body indirect calorimetry measurementsEuropean Journal of Clinical Nutrition, 2004
- Body mass index, dialysis modality, and survival: Analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II StudyKidney International, 2004
- Endocrinology and Dialysis: Issue and Therapies Series Editor: Jean L. Holley: Pregnancy in Dialysis Patients: A Review of Outcomes, Complications, and ManagementSeminars in Dialysis, 2003
- Climatic influences on basal metabolic rates among circumpolar populationsAmerican Journal of Human Biology, 2002
- Explaining Counter‐Intuitive Clinical Outcomes Predicted by Kt/VSeminars in Dialysis, 2001
- Do African Americans have lower energy expenditure than Caucasians?International Journal of Obesity, 2000
- Relationships between resting and total energy expenditure in injured and septic patientsCritical Care Medicine, 1994