Assessment of Hemodialysis Adequacy by Online Clearance Monitoring

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Murukeshan Anandi

DOI: 10.69097/41-06-2024-11

Murukeshan Anandi1, Muniappan Muthamizh1, Suyampirakasam Ilango1, Varadharajan Jayaprakash1

1 Department of Nephrology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India 603202

Corresponding author:
Muniappan Muthamizh
Department of Nephrology
SRM Medical College Hospital and Research Centre
Kattankulathur, Tamilnadu, India 603202
Mail: muthamizhhene@gmail.com; muthamim@srmist.edu.in
Contact: 9092133946

 

Abstract

Measuring the uremic solute clearance is an important factor in analyzing the adequacy of maintenance hemodialysis (MHD) therapy. Conventionally hemodialysis (HD) adequacy was measured by urea removal through the Daugirdas single pool kt/V (spKt/V) formula. We aimed in our study to correlate online clearance monitoring (OCM) spKt/V to the Urea Reduction Ratio (URR) and Daugirdas spKt/V in maintenance hemodialysis patients. This single-center cross-sectional study, conducted at the hemodialysis unit in the nephrology department of SRM Medical College Hospital and Research Center, involved 100 participants undergoing maintenance hemodialysis (MHD) therapy for 200 sessions. The OCM with URR and Daugirdas spKt/V values were obtained from each session and the results were analyzed using SPSS software with p <0.05 significance. In the results, we found that the OCM spKt/V, Daugirdas spKt/V, and URR showed positive correlations. These results emphasize that OCM can be an alternative method to assess dialysis adequacy for every session without the need for repeated blood sampling. Keywords: Hemodialysis, Adequacy, Online clearance monitoring, spKt/V

Introduction

Hemodialysis (HD) is the most common form of renal replacement therapy (RRT). Measuring the dialysis-delivered dose is an important factor in analyzing the adequacy of patients undergoing maintenance hemodialysis (MHD) therapy. Conventionally, HD adequacy was measured by sampling blood at pre- and post-hemodialysis therapy to calculate the urea removal through the Daugirdas spKt/V formula spKt/V = −ln(R-0.008×t) + (4-3.5×R) 0.55×UF/V. However, the drawback of conventional HD adequacy measurement is the requirement for blood sample collection during HD sessions [1].

An alternative non-invasive method named Online Clearance Monitoring (OCM) has evolved and uses a UV absorbance mechanism to measure the urea removal value at the dialysate outlet which calculates the spKt/V in the machine itself and provides the delivered dialysis dose at each dialysis session without the need of the blood urea samples [2].

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