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Titolo The Kinetic Behaviors of Urea and Other Marker Molecules During Hemodialysis
Autore E.G. Lowrie
Referenza American Journal of Kidney Diseases 2007; 50 (2): 181-183
Contenuto Extract Kinetic equations intended to explain the behavior of small molecules during a hemodialysis cycle were described more than 30 years ago using urea as an example.1 They have since been extensively debated, developed, and discussed.2 A ratio, the product of urea clearance (K, in mL/min) and dialysis session length (t, in minutes) to the volume of urea distribution in the body (V, in mL), is a key parameter in all such formulations, the Kt/V. It and a related measure, the urea reduction ratio (URR), are currently accepted measures for judging dialysis dose. The real issues here relate to the way small-molecule dialysis is viewed in the combined context of clinical outcome and treatment prescription. The kinetic equations do not include a term for clinical outcome and the kinetic behaviors of small molecules can be very different. Kinetic equations require the division of 1 measure favorably associated with survival by another?the division of Kt by V. The direct measurement of Kt during dialysis, on the other hand, is not so constrained and the association of clearance with outcome has been demonstrated. Therefore, kinetic-related measures should likely be used primarily in research settings to assist better understanding the complex physiology of dialysis. Treatment adequacy should be judged in the clinical setting by simpler and more certain outcome-related measures that can be generalized across a spectrum of small molecules.
Data 14.09.2007
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