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- Title
Urea volume of distribution exceeds total body water in patients with acute renal failure.
- Authors
Himmelfarb, Jonathan; Evanson, James; Hakim, Raymond M.; Freedman, Stephanie; Shyr, Yu; Ikizler, T. Alp
- Abstract
Urea volume of distribution exceeds total body water in patients with acute renal failure.. Background: An accurate estimate of volume of distribution of urea (V[sub urea]) is critically important to guide the prescription of therapy and the quantification of delivered dialysis dose in patients with chronic and acute renal failure (ARF). While V[sub urea] has been shown to be substantially the same as total body water (TBW) in other patient populations, this relationship has not been adequately studied in detail in ARF patients. Methods: To evaluate this question, we undertook a systematic study of these parameters in a cohort of 28 patients with ARF to analyze methods of estimating V[sub urea] and TBW using blood-based kinetic data, anthropometric data and bioelectrical impedance analysis (BIA). Results: The results show that V[sub urea] estimated by double-pool Kt/V (67.9 ± 19.2 L) and by equilibrated Kt/V (61.2 ± 13.6 L) were statistically significantly higher than V[sub urea] determined by single-pool Kt/V (55.3 ± 12.9 L; difference of 16% and 11%, respectively). Determination of TBW by anthropometric measurements (Watson, 42.5 ± 7.0 L; Hume-Weyer, 43.6 ± 7.1 L; Chertow, 46.8 ± 8.1 L) yielded significantly lower measures compared to TBW determined by physiological formulae and by BIA (51.1 ± 11.6 L and 51.1 ± 13.3 L, respectively). Most importantly, all measures of V[sub urea] by blood-based kinetics exceeded TBW measurements by any method (7% to 50% difference). Conclusion: Our results suggest that in terms of useful guidelines to prescribe a specific dose of dialysis in patients with acute renal failure, estimates of TBW cannot be used as a surrogate for V[sub urea] in determining dialysis adequacy.
- Subjects
UREA; ACUTE kidney failure; PHYSIOLOGY; DIAGNOSIS
- Publication
Kidney International, 2002, Vol 61, Issue 1, p317
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.2002.00118.x