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Body composition monitoring-derived urea distribution volume in children on chronic hemodialysis

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Abstract

Background

Modern hemodialysis (HD) machines are able to measure ionic dialysance online and thereby continuously monitor Kt/V. The accuracy of measurement depends on the input of the correct urea distribution volume (V), available from anthropometric equations and body composition monitoring (BCM). The latter method, however, has not been validated in children.

Methods

We compared V determined by BCM to that calculated using four different anthropometric formulas (Morgenstern, Mellits and Cheek, Hume–Weyers and Watson equations) in 23 pediatric HD patients. We also compared online Kt/V using BCM-derived V with the Kt/V calculated from pre- and post-dialytic urea concentrations using the single-pool second-generation Daugirdas equation.

Results

The V calculated by the Morgenstern equation was similar to that derived by BCM, with a mean difference of −0.7 % (95 % limits of agreement −11.7 to 10.3 %). In contrast, the V calculated by the other equations was 5.4, 6.2 and 18 %, respectively higher than the BCM-derived V. The mean difference between Kt/V calculated using the Daugirdas equation and online Kt/V determination based on BCM-derived V data  was 0.10 (95 % limits of agreement −0.50 to 0.70 %).

Conclusions

In our pediatric HD patients the V measured by BCM was in agreement with that calculated using the Morgenstern equation, which is the only equation which has been validated to date in children on dialysis. Online determination of Kt/V using a BCM-derived V largely agreed with that calculated by the Daugirdas equation. We therefore conclude that the former approach is suitable for frequent online assessment of dialytic small solute clearance.

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Acknowledgments

Financial disclosure

CPS has received research grants and lecture honoraria from Fresenius Medical Care.

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Authors and Affiliations

  1. Nephrology Dialysis Transplantation Children’s Unit, University Hospital Hautepierre, 67098, Strasbourg, France

    Ariane Zaloszyc & Michel Fischbach

  2. Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

    Betti Schaefer & Claus Peter Schmitt

  3. Institute of Medical Biometry and Informatics, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany

    Lorenz Uhlmann

  4. Pediatric Nephrology, Hôpital Necker-Enfants Malades, 75015, Paris, France

    Rémi Salomon & Saoussen Krid

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  1. Ariane Zaloszyc
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Correspondence to Claus Peter Schmitt.

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All data were obtained from medical records in accordance with the ethical principles of the Helsinki Declaration of 1975 and revised in 2000. Due to the retrospective nature of this study ethical review board approval or individual parental consent was not required.

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Zaloszyc, A., Fischbach, M., Schaefer, B. et al. Body composition monitoring-derived urea distribution volume in children on chronic hemodialysis. Pediatr Nephrol 31, 991–999 (2016). https://doi.org/10.1007/s00467-015-3283-3

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  • DOI: https://doi.org/10.1007/s00467-015-3283-3

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