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- Title
Evaluation of renal Kt/V as a marker of renal function in predialysis patients.
- Authors
Kuhlmann, Martin K.; Heckmann, Martina; Riegel, Werner; Köhler, Hans
- Abstract
Evaluation of renal Kt/V as a marker of renal function in predialysis patients. Background. The use of renal Kt/V (r-Kt/V) as an indicator for the need of dialysis initiation has been recommended in the NKF-DOQI guidelines. In analogy to clinical practice in peritoneal dialysis, a fall of r-Kt/V below a threshold of 2.0 per week may indicate inadequate renal toxin elimination. However, there are no studies linking r-Kt/V with other parameters of glomerular filtration rate (GFR) in predialysis patients, and the validity of r-Kt/V as parameter for timing of dialysis initiation is unknown. Methods. Renal function was assessed repeatedly in 125 patients (N = 465 measurements). In predialysis patients (r-Kt/V <2.5 per week) r-Kt/V was compared with creatinine [CCr], urea [CUr], averaged creatinine/urea clearance [CCr/Ur], Cockcroft-Gault formula [CCG], and MDRD prediction equation 6 (MDRD6-GFR). The diagnostic performance of r-Kt/V as a parameter for timing the initiation of dialysis was evaluated. Results. Renal Kt/V <2.5 was prevalent in 24.9% of cases (N = 116, mean 1.92 ± 0.34). In this group mean CCr was 13.8 ± 4.9, mean CUr 6.7 ± 1.3, and CCr/Ur 10.2 ± 2.9 mL/min/1.73 m2. There was no correlation of r-Kt/V with serum creatinine and MDRD6-GFR, but a significantly positive correlation with CCr/Ur (r2 = 0.3382, P < 0.001). Sensitivity of r-Kt/V to detect CCr/Ur < 10.5 mL/min/1.73 m2, defined as the threshold for dialysis initiation, was 73.6% with a specificity of 91.9%. Conclusions. These results suggest that r-Kt/V is a parameter of acceptable specificity but poor sensitivity for the timing of dialysis initiation. Additional measures of renal function, such as the average of measured creatinine and urea clearance, also should be taken into consideration when deciding on the timing of...
- Subjects
HEMODIALYSIS; GLOMERULAR filtration rate; CREATININE; CHRONIC kidney failure
- Publication
Kidney International, 2001, Vol 60, Issue 4, p1540
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.2001.00957.x