2. Adequat dialyse Kvalitetssikring
K t / V

3. Hvad er kvalitet…..Effektivitet ?

4. X
Effektivitet =

5. X
Effektivitet =

6. X
Kt/V =
Effektivitet =
Watson ( x age) + ( x height) + ( x weight)

7. Kt/V =
Din renale

8. Kt/V = Din renale = 3,6 pr dag . 25 pr uge X 100 ml/min 1440 min

9. Peritoneal Dialyse Kt/V

10. + Kt/V 24 timers opsamling Måling Total dialyse dræn
Total Residual urin
Total dialyse dræn
Måling 10

11. Målinger Total Urin volumen (liter) u-Carbamid (mmol/l)
u-Kreatinin (mmol/l)
Total drænmængde(liter)
d-Carbamid (mmol/l)
d-kreatinin (mmol/l)
s-carbamid (mmol/l)
s-kreatinin (mmol/l)

12. Alt kan beregnes med en simpel calculator

13. K t / V pr uge Kt/V = dialyse Kt/V + renal Kt/V Body Water (watson)
Renal carbamid Kt/V:
volumen (liter)
u-Carb (mmol/l)
d-Carb (mmol/l)
s-Carb (mmol/l)
u-Carbamid
s-Carbamid
X urin volumen x 7
Body Water (watson)
Dialyse carbamid Kt/V:
d-Carbamid
s-Carbamid
x dialysat volumen x 7
Body Water (watson)
Kt/V = dialyse Kt/V + renal Kt/V

14. (Renal clear. + Dialys clear.) x 1,73 m2
Kreatinin Clearance
Renal kreatininclearance (GFR):
u-kreatinin x volumen +
u-carb x volumen
volym (liter)
u-Urea (mmol/l)
u-Kreatinin (mmol/l)
d-Urea (mmol/l)
d-kreatinin (mmol/l)
s-Urea (mmol/l)
s-kreatinin (mmol/l)
S-kreatinin
S-urea 2
Dialyse kreatininclearance:
d-kreatinin
s-kreatinin
x dialysat volumen
Om man endast räknar u-kreatinin/s-kreatinin så får man ett falskt högt renalt kreatininclearace då kreatinin inte bara filtreras i glumeruli utan dessutom sekreeras i tubuli
Total normaliseret kreatinin clearance:
(Renal clear. + Dialys clear.) x 1,73 m2
Patientens BSA 14

17. Protein Catabolic Rate (nPCR) Calculations
Randerson nPCR
nPCR = * {[Urea Generation Rate (mmol/min) * 60.06] } / Weight in kg
Bergstrom nPCR
nPCR = {19 + (0.213 * Urea Appearance Rate)} / Weight in kg
Urea Appearance Rate = {[24 hour Urine(mLs) * Urine Urea (mmol/L)] +
[24 hour Drain Volume * Dialysate Urea(mmol/L)]} / 1000

19. Ideal Body Weight Kun effekt på beregninger af nPCR.
Total Body Water og BSA bruger stadig aktuelle vægt.

24. Målsætning ?
Kvalitet og Kt/V

25. 1996: CANUSA : mortality decreased by 6% for each 0
1996: CANUSA : mortality decreased by 6% for each 0.1 u/week increase in weekly Kt/Vurea, and decreased by 7% for each 5L/week/1.73m2 increase in creatinine clearance.
2001: CANUSA reanalysis: (1) PD outcome was predicted by renal Kt/Vurea but not peritoneal Kt/Vurea, (2) changes in survival over time were due to changes in residual renal function, (3) each 5L/week renal GFR was associated with a 12% survival benefit.
2002: ADEMEX: 965 CAPD patients in Mexico  
The study achieved a good separation between the two groups (pCcr of 46 vs. 57 L/week/1.73m2). There was no difference in survival at the end of 2 years. Interestingly, the overall mortality rates in this study were similar to the 2 year survival rates seen in the HEMO trial, which evaluated the effect of dialysis dose on outcomes in hemodialysis.
2003: Hong Kong Trial : 320 incident PD patients were randomized to three target pKt/Vurea goals ( , , and > 2.0). This study achieved good separation between the groups, and residual renal function was the same in all groups. There was no difference in survival between the groups; however,
the lowest Kt/V group (pKt/Vurea ) exhibited more dropout due to inadequate dialysis, and also require higher doses of ESA to achieve hemoglobin targets.

26. ISPD GUIDELINES/RECOMMENDATIONS
Egen nyrefunktion er godt
Residual renal function (measured by renal clearance
or urine volume), but not peritoneal clearance, is
predictive of survival in prospective observational
studies and can account for most of the association
between total clearance and survival
Mere dialyse ingen effekt
Prospective randomized interventional studies do
not provide evidence to support a beneficial effect
of increasing dialysis to total Kt/V urea above 2.0,
or creatinine clearance above 60 L/week/1.73 m2,
in patients on continuous ambulatory peritoneal di-
alysis (CAPD) with a total Kt/V urea above 1.70
For lidt dialyse ikke godt
Interventional studies have demonstrated that total
Kt/V below 1.70 is associated with poorer primary
or secondary outcome.

27. Adequacy of dialysis should be interpreted clinically
ISPD GUIDELINES/RECOMMENDATIONS
Adequacy of dialysis should be interpreted clinically
rather than by targeting only solute and fluid removal.

28. Trivsel
Energi
Job
Ca-P-PTH BT
Ødemer
Anæmi
……..
…….

29. Målsætning
Kvalitet og Kt/V
K t / V >= 1.7

30. d -carbamid = 25 (100 % mætning) bags = 8 - 12 liter/dag
Maximum Kt/V
80 kg
Water = 40 L
se-carbamid = 25
d -carbamid = 25 (100 % mætning)
bags = liter/dag
( D- Carbamid X D-Volumen Ud/ S-Carbamid ) / Body Water
poser ialt 8 L : (25 x 8 / ) / = 0,2 day ---> 1,4 weekly
poser ialt 12 L : (25 x 12 / ) / = 0,3 day ---> 2,1 weekly

32. Regimen predictions 50 80

33. Optimization results

34. Monitor individual patient's clearances over time

35. The Group Distribution