ESTIMATING EQUILIBRATED KT/V FROM AN INTRADIALYTIC SAMPLE - EFFECTS OF ACCESS AND CARDIOPULMONARY RECIRCULATIONS

The Smye method has been proposed to estimate the equilibrated post-dialysis BUN based on an additional intradialytic sample obtained approximately one hour into dialysis. However, the effects of access recirculation (AR) and cardiopulmonary recirculation (CPR) on the Smye computation and the corresponding details of how blood is sampled have not been studied We examined the accuracy of two variations of the Smye technique. In one method, the intradialytic and postdialysis blood samples were obtained at full blood flow. In the other, the samples were obtained after two minutes of slow flow, to obviate the effects of both AR and CPR. Seventeen patients undergoing high efficiency dialysis and three- to four-hour treatment times were studied, in whom substantial AR was excluded based on two-minute slow flow urea rebound measurements during and just after dialysis. In this group equilibrated Kt/V (eKt/V) values computed using the Smye-derived equilibrated postBUN estimates (full flow samples, 1.22 +/- 0.058 SEM, slow how samples, 1.23 +/- 0.064) were similar to eKt/V calculated from the 30-minute postdialysis BUN specimen (1.23 +/- 0.049, P = NS). In eight other patients with severe AR (mean 35% +/- 4.5), the accuracy of the full flow Smye estimates was poor when the degree of AR was not constant throughout the dialysis session. Accuracy of the slow flow Smye estimates of eKt/V was unaffected by the presence of severe AR. One advantage of using the full how Smye method, however, was that a large triangle Kt/V value (< -0.40) was highly suggestive of severe AR. The results confirm the utility of the Smye method to estimate eKt/V, but suggest that the full flow Smye method may not accurately predict rebound in patients with severe AR when the latter is not constant throughout dialysis.