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Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis

Sunny Eloot UGent, Wim Van Biesen UGent, Annemieke Dhondt UGent, RITA DE SMET UGent, Bart Marescau, Peter Paul De Deyn, Pascal Verdonck UGent and Raymond Vanholder UGent (2009) NEPHROLOGY DIALYSIS TRANSPLANTATION. 24(7). p.2225-2232
abstract
Background. Patients with renal failure retain a large variety of uraemic solutes, characterized by different kinetic behaviour. It is not entirely clear what the impact is of increasing dialysis frequency and/or duration on removal efficiency, nor whether this impact is the same for all types of solutes. Methods. This study was based on two-compartmental kinetic data obtained in stable haemodialysis patients (n = 7) for urea, creatinine (CREA), guanidinosuccinic acid (GSA) and methylguanidine (MG). For each individual patient, mathematical simulations were performed for different dialysis schedules, varying in frequency, duration and intensity. For each dialysis schedule, plasmatic and extraplasmatic weekly time-averaged concentrations (TAC) were calculated, as well as their %difference to weekly TAC of the reference dialysis schedule (three times weekly 4 h). Results. Increasing dialysis duration was most beneficial for CREA and MG, which are distributed in a larger volume (54.0 +/- 5.9 L and 102.6 +/- 33.9 L) than urea (42.7 +/- 6.0 L) [plasmatic weekly TAC decrease of 31.5 +/- 3.2% and 31.8 +/- 3.8% for CREA and MG with Q(B) of 200 mL/min, compared to 25.7 +/- 3.2% for urea (P = 0.001 and P < 0.001)]. Increasing dialysis frequency resulted only in a limited increase in efficiency, most pronounced for solutes distributed in a small volume like GSA (30.6 +/- 4.2 L). Increasing both duration and frequency results in weekly TAC decreases of > 65% for all solutes. Comparable results were found in the extraplasmatic compartment. Conclusion. Prolonged dialysis significantly reduces solute concentration levels, especially for those solutes that are distributed in a larger volume. Increasing both dialysis frequency and duration is the superior dialysis schedule.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
PLASMA, BETA(2)-MICROGLOBULIN, BEHAVIOR, DIALYSIS, SERUM PHOSPHATE, NOCTURNAL HEMODIALYSIS, PHOSPHATE REMOVAL, UREMIC RETENTION SOLUTES, prolonging, kinetics, compartmental behaviour, frequency, haemodialysis, DISEASE, MODEL
journal title
NEPHROLOGY DIALYSIS TRANSPLANTATION
Nephrol. Dial. Transplant.
volume
24
issue
7
pages
2225 - 2232
Web of Science type
Article
Web of Science id
000267226500038
JCR category
UROLOGY & NEPHROLOGY
JCR impact factor
3.306 (2009)
JCR rank
13/61 (2009)
JCR quartile
1 (2009)
ISSN
0931-0509
DOI
10.1093/ndt/gfp059
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
669391
handle
http://hdl.handle.net/1854/LU-669391
date created
2009-05-27 15:53:21
date last changed
2012-10-30 16:10:54
@article{669391,
  abstract     = {Background. Patients with renal failure retain a large variety of uraemic solutes, characterized by different kinetic behaviour. It is not entirely clear what the impact is of increasing dialysis frequency and/or duration on removal efficiency, nor whether this impact is the same for all types of solutes.
Methods. This study was based on two-compartmental kinetic data obtained in stable haemodialysis patients (n = 7) for urea, creatinine (CREA), guanidinosuccinic acid (GSA) and methylguanidine (MG). For each individual patient, mathematical simulations were performed for different dialysis schedules, varying in frequency, duration and intensity. For each dialysis schedule, plasmatic and extraplasmatic weekly time-averaged concentrations (TAC) were calculated, as well as their \%difference to weekly TAC of the reference dialysis schedule (three times weekly 4 h). 
Results. Increasing dialysis duration was most beneficial for CREA and MG, which are distributed in a larger volume (54.0 +/- 5.9 L and 102.6 +/- 33.9 L) than urea (42.7 +/- 6.0 L) [plasmatic weekly TAC decrease of 31.5 +/- 3.2\% and 31.8 +/- 3.8\% for CREA and MG with Q(B) of 200 mL/min, compared to 25.7 +/- 3.2\% for urea (P = 0.001 and P {\textlangle} 0.001)]. Increasing dialysis frequency resulted only in a limited increase in efficiency, most pronounced for solutes distributed in a small volume like GSA (30.6 +/- 4.2 L). Increasing both duration and frequency results in weekly TAC decreases of {\textrangle} 65\% for all solutes. Comparable results were found in the extraplasmatic compartment. 
Conclusion. Prolonged dialysis significantly reduces solute concentration levels, especially for those solutes that are distributed in a larger volume. Increasing both dialysis frequency and duration is the superior dialysis schedule.},
  author       = {Eloot, Sunny and Van Biesen, Wim and Dhondt, Annemieke and DE SMET, RITA and Marescau, Bart and De Deyn, Peter Paul and Verdonck, Pascal and Vanholder, Raymond},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {PLASMA,BETA(2)-MICROGLOBULIN,BEHAVIOR,DIALYSIS,SERUM PHOSPHATE,NOCTURNAL HEMODIALYSIS,PHOSPHATE REMOVAL,UREMIC RETENTION SOLUTES,prolonging,kinetics,compartmental behaviour,frequency,haemodialysis,DISEASE,MODEL},
  language     = {eng},
  number       = {7},
  pages        = {2225--2232},
  title        = {Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis},
  url          = {http://dx.doi.org/10.1093/ndt/gfp059},
  volume       = {24},
  year         = {2009},
}

Chicago
Eloot, Sunny, Wim Van Biesen, Annemieke Dhondt, RITA DE SMET, Bart Marescau, Peter Paul De Deyn, Pascal Verdonck, and Raymond Vanholder. 2009. “Impact of Increasing Haemodialysis Frequency Versus Haemodialysis Duration on Removal of Urea and Guanidino Compounds: a Kinetic Analysis.” Nephrology Dialysis Transplantation 24 (7): 2225–2232.
APA
Eloot, Sunny, Van Biesen, W., Dhondt, A., DE SMET, R., Marescau, B., De Deyn, P. P., Verdonck, P., et al. (2009). Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis. NEPHROLOGY DIALYSIS TRANSPLANTATION, 24(7), 2225–2232.
Vancouver
1.
Eloot S, Van Biesen W, Dhondt A, DE SMET R, Marescau B, De Deyn PP, et al. Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2009;24(7):2225–32.
MLA
Eloot, Sunny, Wim Van Biesen, Annemieke Dhondt, et al. “Impact of Increasing Haemodialysis Frequency Versus Haemodialysis Duration on Removal of Urea and Guanidino Compounds: a Kinetic Analysis.” NEPHROLOGY DIALYSIS TRANSPLANTATION 24.7 (2009): 2225–2232. Print.