Simulating inadequate dialysis and its correction using an individualized patient-derived nomogram

Pediatr Nephrol. 2009 Dec;24(12):2429-38. doi: 10.1007/s00467-009-1241-7. Epub 2009 Jul 16.

Abstract

Computerized kinetic modeling is a valuable automated peritoneal dialysis (APD) prescription tool for optimizing dialysis adequacy. However, non-compliance results in failure to achieve adequacy targets. The aim of this study was to determine if a nomogram could estimate dialysis compensations for shortfalls in simulated non-compliant patients, such that total weekly urea clearance (Kt/V(urea)) targets are met. Individualized nomograms comprising a series of curves were derived from PD Adequest (ver. 2.0)-predicted Kt/V(urea) data (r (2 ) > 0.99) for different APD prescriptions. The nomogram was then used to estimate the (Nomogram-computed) average of the daily Kt/V(urea) in 14 patients. The study comprised three 1-month phases. Patients were compliant to dialysis in phase I, where Adequest-predicted Kt/V(urea) showed good agreement with both measured (r (I) = 0.72), and Nomogram-computed values (r (I) > 0.99) (p < 0.001). Conversely, in non-compliant phase II, Nomogram-computed values were lower than Adequest-predicted values (p < 0.002). In phase III, the nomogram estimated prescription adjustments required to compensate for shortfalls, such that there was significantly less difference between Nomogram-computed and Adequest-predicted Kt/V(urea) than in phase II (p = 0.005). Thus, despite non-compliance, predicted Kt/V(urea) targets were attained using the nomogram to adjust the daily APD prescriptions. This concept is potentially useful for patients desiring to compensate for inadvertent shortfalls, rather than for 'truly non-compliant' patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Computer Simulation*
  • Creatinine / blood
  • Creatinine / urine
  • Female
  • Glucose / pharmacokinetics
  • Humans
  • Kinetics
  • Longitudinal Studies
  • Male
  • Metabolic Clearance Rate
  • Models, Statistical
  • Monitoring, Physiologic
  • Nomograms*
  • Patient Compliance*
  • Peritoneal Dialysis*
  • Peritoneal Dialysis, Continuous Ambulatory*
  • Peritoneum / metabolism
  • Prescriptions
  • Therapy, Computer-Assisted
  • Urea / blood
  • Urea / urine

Substances

  • Urea
  • Creatinine
  • Glucose