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Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study.


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.

SUBMITTER: Meyer TW 

PROVIDER: S-EPMC5084890 | biostudies-other | 2016 Nov

REPOSITORIES: biostudies-other

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Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study.

Meyer Timothy W TW   Sirich Tammy L TL   Fong Kara D KD   Plummer Natalie S NS   Shafi Tariq T   Hwang Seungyoung S   Banerjee Tanushree T   Zhu Yunnuo Y   Powe Neil R NR   Hai Xin X   Hostetter Thomas H TH  

Journal of the American Society of Nephrology : JASN 20160329 11


The Hemodialysis (HEMO) Study showed that high-dose hemodialysis providing a single-pool Kt/V<sub>urea</sub> of 1.71 provided no benefit over a standard treatment providing a single-pool Kt/V<sub>urea</sub> 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  ...[more]

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