The online measurement of hemodialysis dose (Kt): Clinical outcome as a function of body surface area

Abstract

Background. Recent advances enable the direct measurement of small molecule clearance, Kecn, during each dialysis. Average Keen and treatment length, t, are multiplied giving total clearance, Kt. The body surface area (BSA) is a fixed transformation of height and weight and is a well recognized measure of body size. This project was conceived to search for clinical outcome-based functions for measured Kt in terms of BSA to enable simple Kt prescription guidelines for clinicians who are able to measure Keen, and to provide foundations for future clinical research. Methods. The data came from Fresenius Medical Care (NA) files and included more than 32,000 patients with height, weight, and paired Keen and t measurements during December 2002. Measurements were averaged for the month and used as predictor measures in Cox models of survival time during 2003. Candidate Kt values from 30 L/treatment through 70 were examined to determine the best statistical fit for quintile and decile delimited BSA groups evaluating the best fit Kt treatment target for each group. Functional forms representing the relationship between target Kt values and mean BSA of the groups were then evaluated to determine the best fit. Results. Kt targets increased with BSA in a curvilinear way such that the rate of increase is greater at low BSA than high. The best statistical fit was a double reciprocal form, Kt = 1/(a + b/BSA); "a" and "b" are statistically derived coefficients. The form has an appealing mathematical property; Kt approaches 0 as BSA approaches 0. Other forms fit the data nearly as well, however, and can be used to estimate Kt targets for patients with different BSA. Conclusion. Empirical, outcome-based functions of measured Kt in terms of BSA exist and can be used as aids for prescribing and judging hemodialysis treatment. © 2005 by the International Society of Nephrology.