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Simulating inadequate dialysis and its correction using an individualized patient-derived nomogram

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Abstract

Computerized kinetic modeling is a valuable automated peritoneal dialysis (APD) prescription tool for optimizing dialysis adequacy. However, non-compliance results in failure to achieve adequacy targets. The aim of this study was to determine if a nomogram could estimate dialysis compensations for shortfalls in simulated non-compliant patients, such that total weekly urea clearance (Kt/Vurea) targets are met. Individualized nomograms comprising a series of curves were derived from PD Adequest (ver. 2.0)-predicted Kt/Vurea data (r 2  > 0.99) for different APD prescriptions. The nomogram was then used to estimate the (Nomogram-computed) average of the daily Kt/Vurea in 14 patients. The study comprised three 1-month phases. Patients were compliant to dialysis in phase I, where Adequest-predicted Kt/Vurea showed good agreement with both measured (r I = 0.72), and Nomogram-computed values (r I > 0.99) (p < 0.001). Conversely, in non-compliant phase II, Nomogram-computed values were lower than Adequest-predicted values (p < 0.002). In phase III, the nomogram estimated prescription adjustments required to compensate for shortfalls, such that there was significantly less difference between Nomogram-computed and Adequest-predicted Kt/Vurea than in phase II (p = 0.005). Thus, despite non-compliance, predicted Kt/Vurea targets were attained using the nomogram to adjust the daily APD prescriptions. This concept is potentially useful for patients desiring to compensate for inadvertent shortfalls, rather than for ‘truly non-compliant’ patients.

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Authors and Affiliations

  1. Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, 119074, Singapore, Singapore

    Alison Joanne Lee, Kevin Kho & Hui-Kim Yap

  2. Center for Molecular Epidemiology and Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Kee-Seng Chia

  3. Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore

    Tze-Liang Oi & Christopher Yap

  4. Shaw-NKF Children’s Kidney Centre, University Children’s Medical Institute, National University Health System, Singapore, Singapore

    Pei-Pei Foong, Yew-Weng Lau, Lee-Kean Lim, Eric Aragon & Chien-Wyei Liew

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  1. Alison Joanne Lee
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  2. Kevin Kho
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  3. Kee-Seng Chia
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  4. Tze-Liang Oi
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  5. Christopher Yap
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  8. Lee-Kean Lim
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  11. Hui-Kim Yap
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Correspondence to Hui-Kim Yap.

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Lee, A.J., Kho, K., Chia, KS. et al. Simulating inadequate dialysis and its correction using an individualized patient-derived nomogram. Pediatr Nephrol 24, 2429–2438 (2009). https://doi.org/10.1007/s00467-009-1241-7

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  • DOI: https://doi.org/10.1007/s00467-009-1241-7

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