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Commentary by Todd S. Ing, MD

Dr. Leypoldt asserts in the present communication that the standard Kt/V_urea concept is based on the hypothesis that equal peak or predialysis concentrations of a water-soluble uremic toxin in blood, such as urea, predict equivalent overall patient outcomes. Indeed, this standard Kt/V value, the brainchild of Gotch^1,2, may serve as a universal dose gauge for hemodialysis therapies of arbitrary length and frequency. Formulas and nomograms depicting the relationship between the single-pool Kt/V per treatment and the weekly standard Kt/V for various treatment durations and different treatment frequencies have been reported^1,3,4. In the instance of 6 times per week, short daily hemodialysis therapy, the minimum per-session, single-pool Kt/V corresponding to a weekly standard Kt/V of approximately 2.0 (for patients with a residual renal function of less than 2 mL/min/1.73 square meters surface area) has been suggested by Kidney Disease Outcomes Quality Initiative (KDOQI) to be 0.5⁵. [It is noteworthy that a weekly standard Kt/V value of 2.1 is closely equivalent to that dialysis dose provided by 3 conventional, thrice weekly (e.g., 3.5 hours per session) hemodialysis treatments with a single-pool Kt/V level of 1.2 each¹]. Future studies are required to determine if this novel standard Kt/V concept is the dialysis adequacy measure of choice.

References

1. Gotch FA. The current place of urea kinetic modeling with respect to different dialysis modalities. Nephrol Dial Transplant 1998;13 (Suppl 6):S10-4.
2. Gotch FA. Modeling the dose of home dialysis. Home Hemodial Int 1999;3:37-40.
3. Leypoldt JK, Jaber BL, Zimmerman DL. Predicting treatment dose for novel therapies using urea standard Kt/V. Semin Dial 2004;17:142-5.
4. Leypoldt JK, Jaber BL, Zimmerman DL. Calculation of standard Kt/V (stdKt/V) with corrections for postdialysis urea rebound (abstract). Hemodial Int 2003;7:80.
5. Clinical practice recommendations for guideline 4: Minimally adequate hemodialysis. National Kidney Foundation KDOQI clinical practice guidelines and clinical practice recommendations. 2006 updates. Hemodialysis adequacy. Am J Kidney Dis 2006;48 (Suppl 1):S53-62 (Table 13).

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