Analysis Of Factors Associated With Urea Kinetic Model During Hemodialysis

Objective:To investigate the feasibility and accuracy of Kt/V by online conductivity monitoring(Kt/Vcon) in assessing hemodialysis adequancy by a prospective auto-control study,and analyse the related factors.The subject of this thesis is provide clinical data for integra machine equipped with the online conductivity monitoring module for the automatic determination of Kt/V.Method:We studied 105 treatments in 35 patiens with maintenance hemodialysis at lest for six months.Kt/V was automatically recorded on JH—2000 machine.Single pool Kt/V (spKt/V) and the equilibrated Kt/V(eKt/V) were calculated from pre-dialysis and post-dialysis urea concentration,using the second-generation formula of Daugirdas and the equation Daugirdas respectly.We compared Kt/V obtained using the conductivity online method and that calculated from urea measurements,and analysed the related factors such as ultrafiltration volume,blood flow,transmembrane pressure(TMP),venous line pressure,sodium removal,dialyzer reuse and heparin dose.Result:There is highly correlation between single pool Kt/V(spKt/V) and online conductivity-based Kt/V(Kt/Vcon),r=0.654,Y=0.69+0.65X.Correlation coefficient between online conductivity-based Kt/V(Kt/Vcon)and the equilibrated Kt/V(eKt/V) was 0.661,Y=0.33 +0.53X.Our studies showed that Kt/V obtained using conductivity online monitoring overestimated Kt/V calculated from urea measurements and showed a positive correlation.In Our studies Kt/Vcon was negatively correlated with mean venous pressure,sodium removal,dry body weight and height,and conversely,it was positively correlated with minimum transmembrane pressure(TMP).Heparin dose appeared to influence Kt/Vcon as well as blood flow,but dialyzer reuse(≤6times),ultrafiltration volume and interdialytic weight gains did not.Conclusion:The online conductivity monitoring module in our study is a safe and accurate tool for the automatic determination of Kt/V.It is a new way we can adjust hemodialysis project in time.The analysis indicated that the Kt/Vcon was associated with mean venous pressure, sodium removal,dry body weight and height,minimum transmembrane pressure(TMP),heparin dose and blood flow.