FlashMed

Titolo	Assessment of urea removal in haemodialysis and the impact of the European best practice guidelines
Autore	C´ecile Couchoud1, Kitty J. Jager2, Charlie Tomson3, Jean-Franc¸ois Cabanne4, Frederic Collart5, Patrik Finne6, Angel de Francisco7, Luc Frimat8, Liliana Garneata9, Torbjørn Leivestad10, Vincent Lemaitre11, Aurelio Limido12, Mai Ots13, Halima Resic14, Olivera Stojceva-Taneva15 and Jeroen Kooman16 On behalf of the QUEST working group on dialysis adequacy - 1French ESRD Registry REIN, Agence de la biomedecine, Saint-Denis La Plaine, France, 2Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, 3UK Renal Registry, Bristol, UK, 4REIN registry in Bourgogne, Ch?alon sur Sa?one, France, 5French-Speaking Belgium Renal Registry, Bruxelles, Belgium, 6Finnish Registry for Kidney Disease, Helsinki, Finland, 7Spanish Society of Nephrology, Santander, Spain, 8REIN registry in Lorraine, Vanedoeuvre-les-Nancy, France, 9Romanian Renal Registry, Bucarest, Romania, 10Norway Renal Registry, Oslo, Norway, 11REIN registry in Nord-Pas de Calais, Valenciennes, France, 12Italian Renal Registry, Gallarate, Italy, 13Estonian Renal Registry, Tartu, Estonia, 14Bosnia Herzegovina Renal Registry, Sarajevo, Bosnia Herzegovina, 15Macedonian Renal Registry, Skopje, FYR of Macedonia and 16University hospital of Maastricht, Maastricht, The Netherlands
Referenza	Nephrol Dial Transplant 2008; doi: 10.1093/ndt/gfn641
Contenuto	Background. Dialysis adequacy, assessed by urea kinetics, is an important determinant of patient outcome, and is therefore an important clinical performance indicator. In this perspective, renal registry data may be useful to compare practices across countries. To serve that purpose available data should be comparable and preferably collected using a standardized procedure. The aim of this study, initiated by the European Renal Association-European Dialysis and Transplantation Association (ERA-EDTA) QUality European STudies (QUEST) initiative, was to make an inventory of the different methods used to determine urea kinetic measurements in the light of the European Best Practice Guidelines. Methods. Via their national and regional registries, European haemodialysis centres were invited to complete a questionnaire regarding their practice of measuring dialysis adequacy. Results. Fourteen regional or national registries among 51 sent back 255 questionnaires. Great variability in the methodology to assess Kt/V was observed. The urea reduction ratio (URR) was used alone by 37% (in association 46%) of dialysis centres, spKt/V by 25% (35%) and online clearance by 4% (12%), whereas only 10% (13%) used eKt/V, as recommended by EBPG. Forty percent of centres measured urea removal less than once a month, 6% ofwhich never measured urea removal and 9% only every 6 months or less frequently. Conclusion. Despite the fact that the use of URR is not recommended by EBPG, it was the most commonly used indicator to measure urea removal, whereas eKt/V was only used by a small minority of centres. This study allowed us to point out the need to standardize definitions and procedures and to develop an effective plan for implementation of the guidelines.
Data	12.01.2009

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