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Complementary parameter for dialysis monitoring based on UV absorbance
Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
2009 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, no 4, 492-497 p.Article in journal (Refereed) Published
Abstract [en]

An optical on-line monitoring system aimed at the estimation of dialysis dose has been tested clinically. The natural logarithmic slope is used to calculate Kt/V(urea) from ultraviolet (UV)-absorbance measurements. Errors in the calculation of Kt/V(urea) may appear due to changes in blood and dialysate flow or due to disturbances when the slope is used to estimate dialysis dose. This study introduces a new parameter for dialysis monitoring that may be used as a complementary parameter, the area under UV-absorbance curve (AUCa), to reflect a total solute removal during dialysis. The aim was to investigate the relationship between this new dialysis on-line monitoring parameter, AUCa, and the total removal of a few solutes. Fifteen patients were monitored during hemodialysis using UV absorbance at the wavelength of 297 nm. All spent dialysate passed through a flow cuvette in a spectrophotometer and then further to a collection tank where solute concentrations in the entire spent dialysate were determined. The AUCa at 297 nm was compared with the total amount of removed solute in the tank (reference method). The result shows strong correlations between AUCa and the total removal of urea, urate, creatinine, and phosphate during a given treatment and less strong correlation in all 15 patients together. A first indication of a new, possible, complementary parameter in hemodialysis treatment is presented, the AUCa, prospected to estimate solute removal.

Place, publisher, year, edition, pages
2009. Vol. 13, no 4, 492-497 p.
Keyword [en]
Area under curve, on-line monitoring, solute removal, total dialysate collection, UV absorbance
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-14195DOI: 10.1111/j.1542-4758.2009.00381.xOAI: oai:DiVA.org:liu-14195DiVA: diva2:22878
Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2017-12-13
In thesis
1. Haemodialysis Treatment Monitored On-line by Ultra Violet Absorbance
Open this publication in new window or tab >>Haemodialysis Treatment Monitored On-line by Ultra Violet Absorbance
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis describes and evaluates an optical method utilizing ultra violet (UV) absorbance for on-line monitoring of haemodialysis treatment. Increased efficiency of haemodialysis treatment is considered to correlate to decreased morbidity and mortality when urea clearance (Kt/V) is elevated. However, further improvements have not been achieved at a higher Kt/V. The mortally rate in the haemodialysis population is still high (27% in Sweden).

Urea as the clinical marker is under discussion, partly due to urea being non-toxic, but also that the uraemic syndrom is the result of a cumulative retention of innumerable involved compounds.

On-line monitoring systems based on urea determination for improved dialysis efficiency have been suggested and developed in different settings over the last two decades, but have not achieved worldwide utilisation as routine clinical equipment. This thesis demonstrates that the UV-technique utilising 280, 285 and 297 nm is capable of estimating dialysis efficiency in therms of Kt/V, nutritional status in terms of protein catabolic rate (PCR), with the same characteristics as existing methods. One novel finding using UV-absorbance with high sampling rates is the on-line visualisation of the clearance process for following variations in clearance caused by clinical events and disturbances as well as during and after adjustments. The fact that the UV-absorbance technique does not measure urea directly but has high correlation to several other both UV-absorbing and not-absorbing solutes makes it suitable to reflect a more overall solute retention process. Finally, a new efficiency parameter based on the calculation of the area under UV- curve (clearance curve), is suggested to reflect the total removal of some solutes.

In summary the UV-technique has the potential to be an additional tool to evaluate improvements of dialysis efficiency, which may result in decreased morbidity, longer life span and enhanced quality of life for the haemodialysis patients.

Place, publisher, year, edition, pages
Institutionen för medicin och vård, 2006
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 962
Series
Keyword
Dialysis, Hemodialysis, Proteins, Metabolism, Renal dialysis, Ultraviolet spectrophotometry, Urea, Uremia
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-7987 (URN)91-85643-65-3 (ISBN)
Public defence
2006-11-10, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2009-06-05

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Uhlin, FredrikPettersson, JonasFernström, AndersLindberg, Lars-Göran

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Hemodialysis International
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