Background/Aims: We derived a novel equation for calculating weekly urea standard Kt/V (stdKt/V) during hemodialysis (HD) based on urea mass removed, comparable to the approach during peritoneal dialysis. Methods: Theoretical consideration of urea mass balance during HD led to the following equation for stdKt/V, namely, stdKt/V = N × (URR + UFV/V), where N is the number of treatments per week, URR is urea reduction ratio per treatment, UFV is ultrafiltration volume per treatment, and V is postdialysis urea distribution volume. URR required corrections for postdialysis rebound and intradialytic urea generation. We compared the accuracy of this approach with previous equations for stdKt/V by numerical simulations using a 2-compartment model of urea kinetics for thrice-weekly and more frequent HD prescriptions. Results: The proposed equation based on urea mass removed predicted values of stdKt/V that are equivalent to those calculated by previous equations for stdKt/V. Conclusion: This work provides a novel approach for calculating stdKt/V during HD and strengthens the theoretical understanding of stdKt/V.

1.
National Kidney Foundation: KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis 2015; 66: 884–930.
2.
European Best Practice Guideline Working Group: Haemodialysis dose quantification: small solutes. Nephrol Dial Transplant 2002; 17(suppl 7): 17–21.
3.
Gotch FA: The current place of urea kinetic modelling with respect to different dialysis modalities. Nephrol Dial Transplant 1998; 13(suppl 6): 10–14.
4.
Daugirdas JT, Depner TA, Greene T, Levin NW, Chertow GM, Rocco MV, et al: Standard Kt/Vurea: a method of calculation that includes effects of fluid removal and residual kidney clearance. Kidney Int 2010; 77: 637–644.
5.
Leypoldt JK, Jaber BL, Zimmerman DL: Predicting treatment dose for novel therapies using urea standard Kt/V. Semin Dial 2004; 17: 142–145.
6.
Blake PG, Daugirdas JT: Adequacy of peritoneal dialysis and chronic peritoneal dialysis prescription; in Daugirdas JT, Blake PG, Ing TS (eds): Handbook of Dialysis, ed 5. Philadelphia, Wolters Kluwer, 2015, pp 464–482.
7.
Henderson LW: Critical interpretation of adequacy parameters in peritoneal dialysis and hemodialysis. Perit Dial Int 1999; 19(suppl 2): S38–S44.
8.
Lindholm B, Waniewski J, Werynski A: Kt/V: the denominator dilemma. Pol Merk Lek 2003; 15: 311–315.
9.
Vonesh EF: Biomathematical modeling of dialysis – the basics. Abstracts of the 24th Annual Conference on Peritoneal Dialysis and the 15th Annual Symposium on Pediatric Dialysis. San Antonio, Texas, USA, February 9–11, 2004. Perit Dial Int 2004; 24:S3–S56.
10.
Greene T, Daugirdas JT, Depner TA, Gotch F, Kuhlman M; Frequent Hemodialysis Network Study Group: Solute clearances and fluid removal in the frequent hemodialysis network trials. Am J Kidney Dis 2009; 53: 835–844.
11.
Clark WR, Leypoldt JK, Henderson LW, Mueller BA, Scott MK, Vonesh EF: Quantifying the effect of changes in the hemodialysis prescription on effective solute removal with a mathematical model. J Am Soc Nephrol 1999; 10: 601–609.
12.
Waniewski J, Debowska M, Lindholm B; Are dialysis adequacy indices independent of solute generation rate? ASAIO J 2014; 60: 90–94.
13.
Daugirdas JT, Leypoldt JK, Akonur A, Greene T, Depner TA; FHN Trial Group: Improved equation for estimating single-pool Kt/V at higher dialysis frequencies. Nephrol Dial Transplant 2013; 28: 2156–2160.
14.
Tattersall JE, DeTakats D, Chamney P, Greenwood RN, Farrington K: The post-hemodialysis rebound: predicting and quantifying its effect on Kt/V. Kidney Int 1996; 50: 2094–2102.
15.
Daugirdas JT, Greene T, Depner TA, Leypoldt J, Gotch F, Schulman G, et al: Factors that affect postdialysis rebound in serum urea concentration, including the rate of dialysis: results from the HEMO Study. J Am Soc Nephrol 2004; 15: 194–203.
16.
Leypoldt JK, Cheung AK, Deeter RB, Goldfarb-Rumyantzev A, Greene T, Depner TA, et al: Kinetics of urea and beta-microglobulin during and after short hemodialysis treatments. Kidney Int 2004; 66: 1669–1676.
17.
Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.
18.
Lin LI: A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989; 45: 255–268.
19.
Daugirdas JT, Depner TA, Greene T, Levin NW, Chertow GM, Rocco MV, et al: Effects of reduced intradialytic urea generation rate and residual renal clearance on modeled urea distribution volume and Kt/V in conventional, daily, and nocturnal dialysis. Semin Dial 2010; 23: 19–24.
20.
Debowska M, Waniewski J, Lindholm B: An integrative description of dialysis adequacy indices for different treatment modalities and schedules of dialysis. Artif Organs 2007; 31: 61–69.
21.
Waniewski J, Debowska M, Lindholm B: Theoretical and numerical analysis of different adequacy indices for hemodialysis and peritoneal dialysis. Blood Purif 2006; 24: 355–366.
22.
Waniewski J, Debowska M, Lindholm B: Can the diverse family of dialysis adequacy indices be understood as one integrated system? Blood Purif 2010; 30: 257–265.
23.
Waniewski J, Lindholm B: Fractional solute removal and KT/V in different modalities of renal replacement therapy. Blood Purif 2004; 22: 367–376.
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