Abstract
Urea kinetic modelling (UKM) has been generally accepted as a method for quantifying hemodialysis (HD) treatment. During hemodialysis, reduction in the urea concentration in the intracellular fluid (ICF) compartment will lag behind that in the extra cellular fluid (ECF) compartment, and following the end of dialysis, a ”rebound” in the blood level of urea will occur where it continues to rise due to diffusion of urea from the ICF to ECF to establish an equilibrium state. Because of compartment effects, the dose of dialysis with regard to urea removal is significantly overestimated from immediate post-dialysis urea concentrations, because 30 to 60 min are required for concentration gradients to dissipate and for urea concentrations to equilibrate across body water spaces during the post-dialysis period. To avoid the delay of waiting for an equilibrated post-dialysis sample, it became necessary to describe and to quantitate effects causing the urea compartmentalization during dialysis; two-pool modeling approaches have been developed that more accurately reflect the amount of urea removed. This in turn gives more adequate measures not only of dialysis adequacy, but also of the protein catabolic rate, an important nutritional measure that is clinically monitored in dialysis patients. This chapter discusses the double pool urea kinetic models and regional blood flow models in order to understand the concept of urea rebound.
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References
Abramson, F., Gibson, S., Barlee, V., Bosch, J.P.: Urea kinetic modeling at high urea clearances: Implications for clinical practice. Adv. Ren. Replace Ther. 1(1), 5–14 (1994)
Alloatti, S., Molino, A., Manes, M., Bosticardo, G.M.: Urea rebound and effectively delivered dialysis dose. Nephrol. Dial. Transplant. 13(6), 25–30 (1998)
Azar, A.T.: Adaptive Neuro Fuzzy system as a novel approach for predicting post-dialysis urea rebound. International Journal of Intelligent Systems Technologies and Applications (IJISTA) 10(3), 302–330 (2011)
Azar, A.T., Wahba, K.M.: Artificial Neural Network for Prediction of Equilibrated Dialysis Dose without Intradialytic Sample. Saudi J. Kidney Dis. Transpl. 22(4), 705–711 (2011)
Azar, A.T., Balas, V.E., Olariu, T.: Artificial Neural Network for Accurate Prediction of Post-Dialysis Urea Rebound (2010), doi:10.1109/SOFA.2010.5565606
Beige, J., Sharma, A.M., Distler, A., et al.: Monitoring dialysis efficacy by comparing delivered and predicted Kt/V. Nephrol. Dial. Transplant. 14(3), 683–687 (1999)
Bhaskaran, S., Tobe, S., Saiphoo, C., et al.: Blood urea levels 30 minutes before the end of dialysis are equivalent to equilibrated blood urea. ASAIO J. 43(5), M759–M762 (1997)
Brahm, J.: Urea permeability of human red cells. J. Gen. Physiol. 82(1), 1–23 (1983)
Burgelman, M., Vanholder, R., Fostier, H., Ringoir, S.: Estimation of parameters in a two-pool urea kinetic model for hemodialysis. Med. Engl. Phys. 19(1), 69–76 (1997)
Canaud, B., Bosc, J.Y., Cabrol, L., et al.: Urea as a marker of adequacy in hemodialysis: lesson from in vivo urea dynamics monitoring. Kidney Int. suppl. 76, S28–S40 (2000)
Canaud, B., Bosc, J.Y., Leblanc, M., et al.: A simple and accurate method to determine equilibrated post-dialysis urea concentration. Kidney Int. 51(6), 2000–2005 (1997)
Cappello, A., Avanzolini, G., Chiari, L.: Estimation of parameters in a two-pool urea kinetic model for hemodialysis. Med. Eng. Phys. 20(4), 315–318 (1998)
Castro, M.C.M., Romao Jr., J.E., Marcondes, M.: Measurement of blood urea concentration during hemodialysis is not an accurate method to determine equilibrated post-dialysis urea concentration. Nephrol. Dial. Transplant. 16(9), 1814–1817 (2001)
Chirananthavat, T., Tungsanga, K., Eiam-Ong, S.: Accuracy of using 30-minute post-dialysis BUN to determine equilibrated Kt/V. J. Med. Assoc. Thai. 89(suppl. 2), 54–64 (2006)
Daugirdas, J.T., Blake, P.G., Ing, T.S. (eds.): Handbook of Dialysis, 4th edn. Lippincott, Williams and Wilkins, Philadelphia (2007)
Daugirdas, J.T., Greene, T., Depner, T.A., et al.: Factors that Affect Post-dialysis Rebound in Serum Urea Concentration, Including the Rate of Dialysis: Results from the HEMO Study. J. Am. Soc. Nephrol. 15(1), 194–203 (2004)
Daugirdas, J.T., Greene, T., Depner, T.A., et al.: Relationship between apparent (single-pool) and true (double-pool) urea distribution volume. Kidney Int. 56(5), 1928–1933 (1999)
Daugirdas, J.T., Depner, T.A., Gotch, F.A., et al.: Comparison of methods to predict equilibrated Kt/V in the HEMO Pilot Study. Kidney Int. 52(5), 1395–1405 (1997)
Daugirdas, J.T., Schneditz, D., Leehey, D.J.: Effect of access recirculation on the modeled urea distribution volume. Am. J. Kidney Dis. 27(4), 512–518 (1996a)
Daugirdas, J.T., Burke, M.S., Balter, P., et al.: Screening for extreme postdialysis urea rebound using the Smye method: patients with access recirculation identified when a slow flow method is not used to draw the postdialysis blood. Am. J. Kidney Dis. 28(5), 727–731 (1996b)
Daugirdas, J.T., Schneditz, D.: Overestimation of hemodialysis dose depends on dialysis efficiency by regional blood flow but not by conventional two pool urea kinetic analysis. ASAIO J. 41(3), M719–M724 (1995)
Daugirdas, J.T.: Estimation of equilibrated Kt/V using the unequilibrated post dialysis BUN. Semin. Dial. 8(5), 283–284 (1995)
Daugirdas, J.T.: Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J. Am. Soc. Nephrol. 4(5), 1205–1213 (1993)
Dedrick, R.L., Bischoff, K.B.: Pharmacokinetics in applications of the artificial kidney. In: Chem. Eng. Prog. Symp. Ser., vol. 64, pp. 32–44 (1968)
Dedrick, R.L., Gabelnick, H.L., Bischoff, K.B.: Kinetics of urea distribution. In: Proc. Ann. Conf. Eng. Med. Biol., vol. 10, 36.1 (1968)
Depner, T.A., Rizwan, S., Cheer, A.Y., et al.: High venous urea concentrations in the opposite arm: A consequence of hemodialysis-induced compartment disequilibrium. ASAIO J. 37(3), 141–143 (1991)
Depner, T.A.: Multicompartment models. In: Depner, T.A. (ed.) Pre-scribing Hemodialysis: A Guide to Urea Modeling, pp. 91–126. Kluwer Academic, Dordrecht (1991)
Duchesne, R., Klein, J.D., Velotta, J.B., et al.: UT-A urea transporter protein in heart: Increased abundance during uremia, hypertension, and heart failure. Circ. Res. 89(2), 139–145 (2001)
Evans, J.H., Smye, S.W., Brocklebank, J.T.: Mathematical modelling of haemodialysis in children. Pediatr. Nephrol. 6(4), 349–353 (1992)
Fernandez, E.A., Valtuille, R., Willshaw, P., Perazzo, C.A.: Using Artificial Intelligence to Predict the Equilibrated Post-dialysis Blood Urea Concentration. Blood Purif. 19(3), 271–285 (2001)
Flanigan, M.J., Fangman, J., Lim, V.S.: Quantitating hemodialysis: A comparison of three kinetic models. Am. J. Kidney Dis. 17(3), 295–302 (1991)
Garred, L.J., Canaud, B., Bosc, J.Y., Tetta, C.: Urea rebound and delivered Kt/V determination with a continuous urea sensor. Nephrol. Dial. Transplant. 12(3), 535–542 (1997)
George, T.O., Priester-Coary, A., Dunea, G., et al.: Cardiac output and urea kinetics in dialysis patients: Evidence supporting the regional blood flow model. Kidney Int. 50(4), 1273–1277 (1996)
Goldstein, S.L., Brewer, E.D.: Logarithmic extrapolation of a 15- minute postdialysis BUN to predict equilibrated BUN and calculate double-pool Kt/V in the pediatric hemodialysis population. Am. J. Kidney Dis. 36(1), 98–104 (2000)
Gotch, F.A., Keen, M.L.: Kinetic modeling in hemodialysis. In: Nissenson, A.R., Fine, R.N. (eds.) Clinical Dialysis, 4th edn., pp. 153–202. McGrraw-Hill, New York (2005)
Grandi, F., Avanzolini, G., Cappello, A.: Analytic solution of the variable-volume double-pool urea kinetics model applied to parameter estimation in hemodialysis. Comput. Biol. Med. 25(6), 505–518 (1995)
Guh, J., Yang, C., Yang, J., Chen, L., Lai, Y.: Prediction of equilibrated postdialysis BUN by an artificial neural network in high-efficiency hemodialysis. Am. J. Kidney Dis. 31(4), 638–646 (1998)
Goldau, R.: Clinical Evaluation of Novel Methods to Determine Dialysis Parameters Using Conductivity Cells. Ph. D. Würzburg University (2002)
Heineken, F.G., Evans, M.C., Keen, M.L., Gotch, F.A.: Intercompartmental fluid shifts in hemodialysis patients. Biotechnol. Progr. 3(2), 69–73 (1987)
Jean, G., Chazot, C., Charra, B., et al.: Is post-dialysis urea rebound significant with long slow hemodialysis? Blood Purif. 16(4), 187–196 (1998)
Jean, G., Charra, B., Chazot, C., Laurent, G.: Quest for post-dialysis urea rebound-equilibrated Kt/V with only intradialytic urea samples. Kidney Int. 56(3), 1149–1153 (1999)
Kaufman, A.M., Schneditz, D., Smye, S., et al.: Solute disequilibrium and multicompartment modeling. Adv. Ren. Replace Ther. 2(4), 319–329 (1995)
Kooman, J.P., van der Sande, F.M., Leunissen, K.M.: Kt/V: Finding the Tree within the Woods. Nephrol. Dial. Transplant. 16(9), 1749–1752 (2001)
Leblanc, M., Charbonneau, R., Lalumiere, G., et al.: Postdialysis Urea Rebound: Determinants and Influence on Dialysis Delivery in Chronic Hemodialysis Patients. Am. J. Kidney Dis. 27(2), 253–261 (1996)
Leypoldt, J.K., Jaber, B.L., Zimmerman, D.L.: Predicting treatment dose for novel therapies using urea standard Kt/V. Semin. Dial. 17(2), 142–145 (2004)
Maduell, F., Garcia-Valdecasas, J., Garcia, H., et al.: Urea reduction ratio considering urea rebound. Nephron 78(2), 143–147 (1998)
Maduell, F., Garcia-Valdecasas, J., Garcia, H., et al.: Validation of different methods to calculate KtV considering postdialysis rebound. Nephrol. Dial. Transplant. 12(9), 1928–1933 (1997)
Malovrh, M.: Non-invasive evaluation of vessels by duplex sonography prior to construction of arteriovenous fistula for haemodialysis. Nephrol. Dial. Transplant. 13(1), 125–129 (1998)
Matthews, D.E., Downey, R.S.: Measurement of urea kinetics in humans: a validation of stable isotope tracer methods. Am. J. Physiol. 246(6 Pt 1), E519–E527 (1984)
Metry, G.S., Attman, P.O., Lönnroth, P., et al.: Urea kinetics during hemodialysis measured by microdialysis–a novel technique. Kidney Int. 44(3), 622–629 (1993)
NKF-K/DOQI: Clinical Practice Guidelines and Clinical Practice Recommendations, Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, Vascular Access. Am. J. Kidney Dis. 48(suppl. 1), S28–S58 (2006)
NKF-K/DOQI: Clinical practice guidelines for hemodialysis adequacy: Update. Am. J. Kidney. Dis. 37(1 suppl. 1), S7–S64 (2001)
Pedrini, L.A., Zereik, S., Rasmy, S.: Causes, kinetics and clinical implications of post-hemodialysis urea rebound. Kidney Int. 34(6), 817–824 (1988)
Pflederer, B.R., Torrey, C., Priester-Coary, A., Lau, A.H., Daugirdas, J.T.: Estimating equilibrated Kt/V from an intradialytic sample: effects of access and cardiopulmonary recirculations. Kidney Int. 48(3), 832–837 (1995)
Renkin, E.M.: Effects of blood flow on diffusion kinetics in isolated, perfused hindlegs of cats; a double circulation hypothesis. Am. J. Physiol. 183(1), 125–136 (1955)
Ronco, C., Brendolan, A., Crepaldi, C., et al.: Ultrafiltrations-rates and dialyse hypotension. Dialyse J. 40, 8–15 (1992)
Sargent, J.A., Gotch, F.A.: Principles and biophysics of dialysis. In: Maher, J.F. (ed.) Replacement of Renal Function by Dialysis, 3rd edn., pp. 87–143. Kluwer Academic, Dordrecht (1989)
Schneditz, D., Platzer, D., Daugirdas, J.T.: A diffusion-adjusted regional blood flow model to predict solute kinetics during haemodialysis. Nephrol. Dial. Transplant. 24(7), 2218–2224 (2009)
Schneditz, D., Daugirdas, J.T.: Compartment effects in hemodialysis. Semin. Dial. 14(4), 271–277 (2001)
Schneditz, D., Fariyike, B., Osheroff, R., Levin, N.W.: Is intercompartmental urea clearance during hemodialysis a perfusion term? A comparison of two pool urea kinetic models. J. Am. Soc. Nephrol. 6(5), 1360–1370 (1995)
Schneditz, D., Daugirdas, J.T.: Formal analytical solution to a regional blood flow and diffusion based urea kinetic model. ASAIO J. 40(3), M667–M673 (1994)
Schneditz, D., VanStone, J., Daugirdas, J.T.: A regional blood circulation alternative to in-series two compartment urea kinetic modeling. ASAIO J. 39(3), M573–M577 (1993)
Schneditz, D., Roob, J., Oswald, M., et al.: Nature and rate of vascular refilling during hemodialysis and ultrafiltration. Kidney Int. 42(6), 1425–1433 (1992a)
Schneditz, D., Kaufman, A.M., Polaschegg, H.D., et al.: Cardiopulmonary recirculation during hemodialysis. Kidney Int. 42(6), 1450–1456 (1992b)
Sharma, A., Espinosa, P., Bell, L., et al.: Multicompartment Urea Kinetics In Well-Dialyzed Children. Kidney Int. 58(5), 2138–2146 (2000)
Sharma, A.K.: Reassessing hemodialysis adequacy in children: The case for more. Pediatr. Nephrol. 16(4), 383–390 (2001)
Sherman, R.A., Kapoian, T.: Recirculation, urea disequilibrium, and dialysis efficiency: Peripheral arteriovenous versus central venovenous vascular access. Am. J. Kidney Dis. 29(4), 479–489 (1997)
Smith, C.P.: Mammalian urea transporters. Exp. Physiol. 94(2), 180–185 (2009)
Smye, S.W., Tattersall, J.E., Will, E.J.: Modeling the postdialysis re-bound: the reconciliation of current formulas. ASAIO J. 45(6), 562–567 (1999)
Smye, S.W., Lindley, E.J., Will, E.J.: Simulating the effect of exercise on urea clearance in hemodialysis. J. Am. Soc. Nephrol. 9(1), 128–132 (1998)
Smye, S.W., Will, E.J.: A mathematical analysis of a two-compartment model of urea kinetics. Phys. Med. Biol. 40(12), 2005–2014 (1995)
Smye, S.W., Dunderdale, E., Brownridge, G., Will, E.: Estimation of treatment dose in high-efficiency haemodialysis. Nephron 67(1), 24–29 (1994)
Smye, S.W., Evans, J.H., Will, E., Brocklebank, J.T.: Paediatric haemodialysis: Estimation of treatment efficiency in the presence of urea rebound. Clin. Phys. Physiol. Meas. 13(1), 51–62 (1992)
Spiegel, D.M., Baker, P.L., Babcock, S., et al.: Hemodialysis urea rebound: the effect of increasing dialysis efficiency. Am. J. Kidney Dis. 25(1), 26–29 (1995)
Star, R., Hootkins, J., Thompson, J., et al.: Variability and stability of two pool urea mass transfer coefficient. J. Am. Soc. Nephrol. 3, 395A (1992)
Tattersall, J., Farrington, K., Bowser, M., et al.: Underdialysis caused by reliance on single pool urea kinetic modeling. J. Am. Soc. Nephrol. 3, 398 (1996a)
Tattersall, J.E., DeTakats, D., Chamney, P., et al.: The post-haemodialysis rebound: predicting and quantifying its effect on KtV. Kidney Int. 50(6), 2094–2102 (1996b)
Tattersall, J.E., Chamney, P., Aldridge, C., Greenwood, R.N.: Recirculation and the post-dialysis rebound. Nephrol. Dial. Transplant. 11(suppl. 2), 75–80 (1996c)
Teichholz, L.E., Kreulen, T., Herman, M.V., et al.: Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am. J. Cardiol. 37(1), 7–11 (1976)
Timmer, R.T., Klein, J.D., Bagnasco, S.M., et al.: Localization of the urea transporter UT-B protein in human and rat erythrocytes and tissues. Am. J. Physiol. Cell Physiol. 281(4), C1318–C1325 (2001)
Yamada, T., Hiraga, S., Akiba, T., et al.: Analysis of Urea Nitrogen and Creatinine Kinetics in Hemodialysis: Comparison of a Variable-Volume Two-Compartment Model with a Regional Blood Flow Model and Investigation of a Appropriate Solute Kinetics Model for Clinical Application. Blood Purif. 18(1), 18–29 (2000)
Yashiro, M., Watanabe, H., Muso, E.: Simulation of post-dialysis urea rebound using regional flow model. Clin. Exp. Nephrol. 8(2), 139–145 (2004)
Vanholder, R., Burgelman, M., De Smet, R., et al.: Two-Pool versus Single-Pool Models in the Determination of Urea Kinetic Parameters. Blood Purif. 14(6), 437–450 (1996)
Wagner, L., Klein, J.D., Sands, J.M., Baylis, C.: Urea transporters are distributed in endothelial cells and mediate inhibition of L-arginine transport. Am. J. Physiol. Renal. Physiol. 283(3), F578–F582 (2002)
Zhao, D., Sonawane, N.D., Levin, M.H., Yang, B.: Comparative transport efficiencies of urea analogues through urea transporter UT-B. Biochim. Biophys. Acta 1768(7), 1815–1821 (2007)
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Azar, A.T., Yashiro, M., Schneditz, D., Roa, L.M. (2013). Double Pool Urea Kinetic Modeling. In: Azar, A. (eds) Modelling and Control of Dialysis Systems. Studies in Computational Intelligence, vol 404. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27458-9_13
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