Davies, SJ and Finkelstein, FO (2020) Accuracy of the estimation of V and the implications this has when applying Kt/Vurea for measuring dialysis dose in peritoneal dialysis. Peritoneal Dialysis International, 40 (3). 261 - 269. ISSN 1718-4304

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BACKGROUND: Current guidelines for the prescription of peritoneal dialysis dose rely on a single cut-off 'minimal' value of Kt/V. To apply this in the clinic, this requires an accurate estimation of V, the volume of urea distribution that equates to the total body water (TBW). This analysis sought to determine the accuracy to which V can be estimated. METHODS: A literature search was undertaken of studies comparing TBW estimation using two or three of the following methods: isotopic dilution (gold standard), anthropometric equations (e.g. Watson formula) and bioimpedance analysis. Studies of healthy and dialysis populations of all ages were included. Mean differences and 95% limits of agreement (LOA) were extracted and pooled. RESULTS: In 44 studies (31 including dialysis subjects), the between-method population means were typically within 1-1.5 L of each other, although larger bias was seen when applying anthropometric equations to different racial groups. However, the 95% LOA for all comparisons were consistently wide, typically ranging ±12-18% of the TBW. For a typical individual whose TBW is 35 L with a measured Kt/V of 1.7, this translates into a range of Kt/V 1.4-2.05. CONCLUSIONS: There are limitations to the accuracy of estimation of V which call into question the validity of applying a single threshold Kt/V value as indicative of adequate dialysis. This should be taken into account in guideline development such that if a target Kt/V was deemed appropriate that this should be expressed as a range; alternatively single targets should be avoided and dialysis dose should be determined according to patient need.

Item Type: Article
Additional Information: The final accepted manuscript and all relevant information regarding this article can be found at; https://journals.sagepub.com/doi/10.1177/0896860819893817
Uncontrolled Keywords: Bioimpedance; body composition; isotope dilution; total body water
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RC Internal medicine > RC902 Nephrology
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 28 May 2020 12:51
Last Modified: 17 Jan 2021 01:30
URI: https://eprints.keele.ac.uk/id/eprint/8055

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