Dialysis Dose Parameters. How Much We Can Improve Them in Our Clinical Practice? Role of Online Conductivity Monitor
Bibliographic record
Abstract
The mortality and morbidity of hemodialysis patients is, to a large extent, determined by demographics and by existing comorbidities, but it is obvious that variations in dialysis dose have substantial effects. Using eKt/V, 1.2 monthly comparisons are recommended by European guidelines, but they assume that dose is maintained during all monthly sessions. Because of dialysis‐related problems like hypotension, reduction of blood flow, dialysis time, microclotting of the dialyzer, and vascular access problems, the delivered dose may vary from session to session. New developed devices based on online conductivity clearance reflect the electrolyte clearance and, thus, clearance of urea. The aim of this prospective study was to show the variability of dialysis dose. 24 anuric patients were studied during 3 months: 20.8% were diabetics, mean age 64.7 ± 18.2 years; 16% females. Access blood were AVFi and the effective dialyzed blood flow was set at 350 mL/min, with recirculation <5%. BMI was 25.4 ± 3.8 kg/m2 and body weight was 69.7 ± 12 kg. All patients were dialyzed thrice weekly (245 ± 21 min) with dialysis machine 4008H (Fresenius Medical Care) equipped with online conductivity monitor (OCM) and the hollow fiber high‐flux polysulfone membrane (HF‐80 1.8 m2) and helixone (Fx‐60, 1.6 m2). OCM was validated for our population and reported in other abstracts (r2 = 0.96, p < 0.001). Dialysate flow was maintained at 500 mL/min, with standard dialysate liquid. Each patient was subjected to OCM on regular sessions during 3 months, and blood Kt/V samples were taken on midweek day, once a month. Data were processed and statistically analyzed with SPSS 11.0 software package. Kt/V OCM relation with other baseline characteristics was assessed by using contingency tables, t‐tests, analysis of variance, and linear regression, as appropriate. All the tests were performed for a 0.05 significance level. The conductivity‐based OCM provides an accurate tool to monitor the dose and control of each hemodialysis session and adds to the efficiency of current dialysis adequacy monitoring. OCM device requires little maintenance, and no extra effort is needed. Monthly Kt/V does not reflect the variability of each session. Further studies are necessary to evaluate its influence on morbidity and mortality. Descriptives Variables Minimum Maximum Mean SD Age (year) 31 86 64.75 18.243 Membrane surface 1.6 1.8 1.675 0.0989 Interdialysis weight gain 500 4200 2266.67 1016.673 BMI 18.22 31.03 25.4155 3.83630 Time on dialysis (min) 210 320 245.21 21.340 OCM 0.990 1.880 1.29921 0.201072 dPVV/Kt/V (Daugirdas) 1.00 2.09 1.4067 0.21924 Watson volume (L) 25.8 49.3 36.833 6.3095
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.007 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".