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Ionic dialysance: a new valid parameter for quantification of dialysis efficiency in acute renal failure?

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Abstract

Objective

Several studies have reported a close relationship between an increased dose of dialysis and survival in patients treated for acute renal failure. Unfortunately, the quantification of dialysis in critically ill patients based on the urea nitrogen formula Kt/V is not applicable. Ionic dialysance is a new parameter calculated in real time from the dialysate conductivity and correlated with the effective urea clearance in chronic hemodialysis patients. The aim of our study was to evaluate ionic dialysance in the quantification of dialysis in critically ill patients with acute renal failure.

Design

Prospective open-label study.

Setting

An 18-bed medical intensive care unit.

Patients

Thirty-one patients with multiple organ dysfunction syndrome and acute renal failure requiring intermittenthemodialysis were included.

Measurements

Using the first dialysis session of each patient, we compared the delivered dose of dialysis based on ionic dialysance measurement (KtID) with the well-accepted gold standard method based on fractional dialysate sampling (Ktdialysate). The data were analyzed using linear regression and Bland–Altman analysis.

Results

Thirty-one intermittent hemodialysis sessions were performed in 31 critically ill patients (mean age 58 ± 12 years, SAPS II score 56 ± 10). We found a close correlation between Ktdialysate and KtID (Ktdialysate = 36.3 ± 11.4 l; KtID = 38.4 ± 11.8; r = 0.96) with excellent limits of agreement (–2.2 l; 6.4 l).

Conclusion

The feasibility of dialysis quantification based on ionic dialysance in the critically ill patient is good. This method is a simple and accurate tool for the determination of dialysis dose in critically ill patients.

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Acknowledgements

We thank E. Rondeau for his advice during the writing of the manuscript and are grateful to the nursing teams.

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Authors and Affiliations

  1. Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Le Kremlin-Bicêtre, Paris, France

    Christophe Ridel, David Osman, Nadia Anguel & Christian Richard

  2. Urgences Néphrologiques et Transplantation rénale, Hôpital Tenon, Assistance publique Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France

    Christophe Ridel

  3. Service de Néphrologie, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France

    Lucile Mercadal

  4. Service de Biophysique, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France

    Thierry Petitclerc

  5. Service des Brûlés, Centre Hospitalo-Universitaire Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V, Paris, France

    Christophe Vinsonneau

Authors
  1. Christophe Ridel
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  2. David Osman
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  3. Lucile Mercadal
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  4. Nadia Anguel
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  5. Thierry Petitclerc
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  6. Christian Richard
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  7. Christophe Vinsonneau
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Correspondence to Christophe Ridel.

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Ridel, C., Osman, D., Mercadal, L. et al. Ionic dialysance: a new valid parameter for quantification of dialysis efficiency in acute renal failure?. Intensive Care Med 33, 460–465 (2007). https://doi.org/10.1007/s00134-006-0514-x

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  • DOI: https://doi.org/10.1007/s00134-006-0514-x

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