Daugirdas JT, Balter P, Burke MS, Priester-Coary A, Majka T
Screening for extreme postdialysis urea rebound using the
Smye method
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Nov) 6:596 1995
The authors (me, actually) were looking for patients with extreme
postdialysis urea rebound using the Smye method, which measures
urea "inbound" as a surrogate for rebound. A sample is taken 1/3
into dialysis, and if it is lower than usual, an excessive degree
of rebound is predicted. Approximately 400 patients were studied
3 months in a row, and 27 were identified with excessive
"inbound" (intradialytic BUN lower than expected), and presumably
excessive rebound. When the deviant patients were restudied,
however, they did have excessive rebound, but only because the
post-dialysis sample was being taken without a period of slow
flow to clear the arterial line deadspace of recirculated blood.
The Kt/V in these patients, based on a post-dialysis BUN that was
taken from the arterial line after simply stopping the blood
pump, appeared to be 1.3, but was actually in the range of 0.7
(equilibrated). The data suggest underscore how important it is
to obtain the post-dialysis BUN sample after a slow flow period,
and suggest that the Smye method may be a way to identify
patients with extreme access recirculation (provided that access
recirculation occurs throughout dialysis).
(Daugirdas)
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Am Soc Nephrol
Basic hemodialysis :
Adequacy, prescription, urea kinetics
Basic hemodialysis :
Vascular Access: graft/fistula