FRACTIONAL DIRECT DIALYSIS QUANTIFICATION - A NEW APPROACH FOR PRESCRIPTION AND MONITORING HEMODIALYSIS THERAPY

We describe a new methodology, fractional direct dialysis quantificati on (FDDQ) utilizing the Fresinius(R) Dialysate Sampling Module (DSM), for quantitating total solute removal during hemodialysis (no). Our da ta demonstrate that this technique and Direct Dialysis Quantification (DDQ) yield virtually identical results. FDDQ, however, obviates the p ractical obstacles that have limited the applicability of DDQ. We disc uss the theoretical and practical advantages of this methodology, as c ompared to urea kinetic modeling (UKM) with Kt/V, for prescribing and monitoring dialysis therapy. FDDQ provides reliable and accurate quant itative data of dialysis function and protein catabolic rate (PCR) ind ependent of questionable theoretical assumptions and parameters requir ed for UKM with Kt/V. It is simple to comprehend and apply. It permits easy comparison of standard and rapid high efficiency dialyses. It al so facilitates the quantitative comparison of HD and continuous therap ies (peritoneal dialysis and various types of continuous hemofiltratio n). FDDQ permits the use of other solutes, in place of or in addition to urea, for the quantitation of HD. Because of its simplicity and pro bable low cost, it can be used with each HD session. It will thus prov ide accurate data on delivered versus prescribed therapy. These featur es should permit more accurate monitoring and lead to a clearer unders tanding of the relationship of outcomes versus delivered dialysis dose , and consequently more effective adjustment of dialysis therapy.