A new review published online ahead of print in Kidney International concludes that Kt/Vurea is “too simple a concept for the complexities of uremia and of today’s dialysis.”
Raymond Vanholder, MD et al, from the Department of Internal Medicine at the Ghent University Hospital in Ghent, Belgium, explain that the concept of using Kt/V to measure dialysis adequacy was developed in the 1980s “when dialysis was almost uniformly short and was applied thrice weekly with small pore cellulosic dialyzers.” Since then dialysis has evolved to involve different methods, including longer sessions, home dialysis, more frequent sessions, and large pore high-flux hemodialysis.
“Although still a useful baseline marker, Kt/Vurea no longer properly covers up for most of these modifications so that urea kinetics are hardly if at all representative for those of other solutes with a deleterious effect on morbidity and mortality of uremic patients. This is corroborated in several clinical studies showing a dissociation between removal of urea and that of other uremic toxins,” the authors wrote in the abstract.
Read the full review (subscription required to read beyond the abstract).
Much of the history of dialysis care, and transplant, can be traced to American roots, but despite our achievements, there are few countries today that would emulate our approach to renal replacement therapy. More