Prescribing the dialysis dose and treatment frequency in home haemodialysis

Francesco Gaetano Casino; Maria Fernanda Slon Roblero; Silvia González-Sanchidrian; Sandra Gallego Dominguez; Ignacio Lorenzo Ferris; Valerie A Luyckx; Vassilios Liakopoulos; Sandip Mitra; Javier Deira Lorenzo; Carlo Basile

doi:10.1093/ndt/gfad212

Prescribing the dialysis dose and treatment frequency in home haemodialysis

Nephrol Dial Transplant. 2024 Feb 28;39(3):445-452. doi: 10.1093/ndt/gfad212.

Affiliations

¹ Dialysis Centre SM2, Policoro, Italy.
² Nephrology Department, Hospital Universitario de Navarra, Pamplona, Spain.
³ Division of Nephrology, San Pedro de Alcantara Hospital, Cáceres, Spain.
⁴ Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Paediatrics and Child Health, University of Cape Town, South Africa.
⁶ Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
⁷ Second Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁸ Manchester Academy of Health Sciences Centre (MAHSC), Manchester University Hospitals and University of Manchester, Manchester, UK.
⁹ Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.

Abstract

Background: There is growing interest in home haemodialysis (HHD) performed with low-flow dialysate devices and variable treatment schedules. The target standard Kt/V (stdKt/V) should be 2.3 volumes/week, according to KDOQI guidelines (2015). The current formula for stdKt/V does not help prescribe the dialysis dose (eKt/V) and treatment frequency (TF). The aim of this study was to obtain a formula for stdKt/V that is able to define the minimum required values of eKt/V and TF to achieve the targeted stdKtV.

Methods: Thirty-eight prevalent patients on HHD were enrolled. A total of 231 clinical datasets were available for urea modelling using the Solute-Solver software (SS), recommended by KDOQI guidelines. A new formula (stdKt/V = a + b × Kru + c × eKt/V) was obtained from multivariable regression analysis of stdKt/V vs eKt/V and residual kidney urea clearance (Kru). The values of coefficients a, b and c depend on the treatment schedules and the day of the week of blood sampling for the kinetic study (labdayofwk) and then vary for each of their foreseen 62 combinations. For practical purposes, we used only seven combinations, assuming Monday as a labdayofwk for each of the most common schedules of the 7 days of the week.

Results: The stdKt/V values obtained with SS were compared with the paired ones obtained with the formula. The mean ± standard deviation stdKt/V values obtained with SS and the formula were 3.043 ± 0.530 and 2.990 ± 0.553, respectively, with 95% confidence interval +0.15 to -0.26. A 'prescription graph' was built using the formula to draw lines expressing the relationship between Kru and required eKt/V for each TF. Using this graph, TF could have been reduced from the delivered 5.8 ± 0.8 to 4.8 ± 0.8 weekly sessions.

Conclusions: The new formula for stdKtV is reliable and can support clinicians to prescribe the dialysis dose and TF in patients undergoing HHD.

Keywords: dialysis rhythms; eKt/V; home haemodialysis; stdKt/V; urea kinetic model.

MeSH terms

Hemodialysis, Home
Humans
Kidney
Kidney Failure, Chronic* / therapy
Renal Dialysis*
Urea

Substances

Urea

Grants and funding

D4D/NIHR