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Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study.
Meyer, Timothy W; Sirich, Tammy L; Fong, Kara D; Plummer, Natalie S; Shafi, Tariq; Hwang, Seungyoung; Banerjee, Tanushree; Zhu, Yunnuo; Powe, Neil R; Hai, Xin; Hostetter, Thomas H.
Afiliação
  • Meyer TW; Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California; twmeyer@stanford.edu.
  • Sirich TL; Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California.
  • Fong KD; Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California.
  • Plummer NS; Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, California.
  • Shafi T; Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
  • Hwang S; Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
  • Banerjee T; Department of Medicine, University of California, San Francisco, California; and.
  • Zhu Y; Department of Medicine, University of California, San Francisco, California; and.
  • Powe NR; Department of Medicine, University of California, San Francisco, California; and.
  • Hai X; Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
  • Hostetter TH; Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
J Am Soc Nephrol ; 27(11): 3469-3478, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27026365
ABSTRACT
The Hemodialysis (HEMO) Study showed that high-dose hemodialysis providing a single-pool Kt/Vurea of 1.71 provided no benefit over a standard treatment providing a single-pool Kt/Vurea of 1.32. Here, we assessed whether the high-dose treatment used lowered plasma levels of small uremic solutes other than urea. Measurements made ≥3 months after randomization in 1281 patients in the HEMO Study showed a range in the effect of high-dose treatment compared with that of standard treatment from no reduction in the level of p-cresol sulfate or asymmetric dimethylarginine to significant reductions in the levels of trimethylamine oxide (-9%; 95% confidence interval [95% CI], -2% to -15%), indoxyl sulfate (-11%; 95% CI, -6% to -15%), and methylguanidine (-22%; 95% CI, -18% to -27%). Levels of three other small solutes also decreased slightly; the level of urea decreased 9%. All-cause mortality did not significantly relate to the level of any of the solutes measured. Modeling indicated that the intermittency of treatment along with the presence of nondialytic clearance and/or increased solute production accounted for the limited reduction in solute levels with the higher Kt/Vurea In conclusion, failure to achieve greater reductions in solute levels may explain the failure of high Kt/Vurea treatment to improve outcomes in the HEMO Study. Furthermore, levels of the nonurea solutes varied widely among patients in the HEMO Study, and achieved Kt/Vurea accounted for very little of this variation. These results further suggest that an index only on the basis of urea does not provide a sufficient measure of dialysis adequacy.
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Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Ureia / Diálise Renal Tipo de estudo: Ensaio clínico controlado Limite: Feminino / Humanos / Masculino / Meia-Idade Idioma: Inglês Revista: J Am Soc Nephrol Assunto da revista: Nefrologia Ano de publicação: 2016 Tipo de documento: Artigo