Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study. Meyer, T. W., Sirich, T. L., Fong, K. D., Plummer, N. S., Shafi, T., Hwang, S., Banerjee, T., Zhu, Y., Powe, N. R., Hai, X., & Hostetter, T. H. Journal of the American Society of Nephrology: JASN, 27(11):3469--3478, November, 2016.
doi  abstract   bibtex   
The Hemodialysis (HEMO) Study showed that high-dose hemodialysis providing a single-pool Kt/Vurea of 1.71 provided no benefit over a standard treatment providing a single-pool Kt/Vurea of 1.32. Here, we assessed whether the high-dose treatment used lowered plasma levels of small uremic solutes other than urea. Measurements made ≥3 months after randomization in 1281 patients in the HEMO Study showed a range in the effect of high-dose treatment compared with that of standard treatment: from no reduction in the level of p-cresol sulfate or asymmetric dimethylarginine to significant reductions in the levels of trimethylamine oxide (-9%; 95% confidence interval [95% CI], -2% to -15%), indoxyl sulfate (-11%; 95% CI, -6% to -15%), and methylguanidine (-22%; 95% CI, -18% to -27%). Levels of three other small solutes also decreased slightly; the level of urea decreased 9%. All-cause mortality did not significantly relate to the level of any of the solutes measured. Modeling indicated that the intermittency of treatment along with the presence of nondialytic clearance and/or increased solute production accounted for the limited reduction in solute levels with the higher Kt/Vurea In conclusion, failure to achieve greater reductions in solute levels may explain the failure of high Kt/Vurea treatment to improve outcomes in the HEMO Study. Furthermore, levels of the nonurea solutes varied widely among patients in the HEMO Study, and achieved Kt/Vurea accounted for very little of this variation. These results further suggest that an index only on the basis of urea does not provide a sufficient measure of dialysis adequacy.
@article{meyer_kt/vurea_2016,
	title = {Kt/{Vurea} and {Nonurea} {Small} {Solute} {Levels} in the {Hemodialysis} {Study}},
	volume = {27},
	issn = {1533-3450},
	doi = {10.1681/ASN.2015091035},
	abstract = {The Hemodialysis (HEMO) Study showed that high-dose hemodialysis providing a single-pool Kt/Vurea of 1.71 provided no benefit over a standard treatment providing a single-pool Kt/Vurea of 1.32. Here, we assessed whether the high-dose treatment used lowered plasma levels of small uremic solutes other than urea. Measurements made ≥3 months after randomization in 1281 patients in the HEMO Study showed a range in the effect of high-dose treatment compared with that of standard treatment: from no reduction in the level of p-cresol sulfate or asymmetric dimethylarginine to significant reductions in the levels of trimethylamine oxide (-9\%; 95\% confidence interval [95\% CI], -2\% to -15\%), indoxyl sulfate (-11\%; 95\% CI, -6\% to -15\%), and methylguanidine (-22\%; 95\% CI, -18\% to -27\%). Levels of three other small solutes also decreased slightly; the level of urea decreased 9\%. All-cause mortality did not significantly relate to the level of any of the solutes measured. Modeling indicated that the intermittency of treatment along with the presence of nondialytic clearance and/or increased solute production accounted for the limited reduction in solute levels with the higher Kt/Vurea In conclusion, failure to achieve greater reductions in solute levels may explain the failure of high Kt/Vurea treatment to improve outcomes in the HEMO Study. Furthermore, levels of the nonurea solutes varied widely among patients in the HEMO Study, and achieved Kt/Vurea accounted for very little of this variation. These results further suggest that an index only on the basis of urea does not provide a sufficient measure of dialysis adequacy.},
	language = {eng},
	number = {11},
	journal = {Journal of the American Society of Nephrology: JASN},
	author = {Meyer, Timothy W. and Sirich, Tammy L. and Fong, Kara D. and Plummer, Natalie S. and Shafi, Tariq and Hwang, Seungyoung and Banerjee, Tanushree and Zhu, Yunnuo and Powe, Neil R. and Hai, Xin and Hostetter, Thomas H.},
	month = nov,
	year = {2016},
	pmid = {27026365},
	pmcid = {PMC5084890},
	keywords = {Female, Hemodialysis Solutions, Humans, Male, Middle Aged, Renal Dialysis, Urea, hemodialysis, hemodialysis adequacy, uremia},
	pages = {3469--3478}
}
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