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dc.contributor.authorSridharan, Sivakumar
dc.contributor.authorWellsted, David
dc.contributor.authorVilar, Enric
dc.contributor.authorDavenport, Andrew
dc.contributor.authorAshman, Neil
dc.contributor.authorK Almond, Michael
dc.contributor.authorBanerjee, Anindya
dc.contributor.authorRoberts, Justin
dc.contributor.authorFarrington, Kenneth
dc.date.accessioned2018-07-25T09:07:03Z
dc.date.available2018-07-25T09:07:03Z
dc.date.issued2018-07-25
dc.identifier.urihttp://hdl.handle.net/2299/20285
dc.description.abstractBackground Current practice basing dialysis dose on urea distribution volume (V), has been questioned. We explored the impact on survival of scaling dialysis dose (Kt) to parameters reflective of metabolic activity. Methods In a multicentre prospective cohort study of 1500 patients on thrice-weekly haemodialysis, body surface area (BSA) and resting energy expenditure (REE) were estimated using validated equations and physical activity by the Recent Physical Activity Questionnaire. Total energy expenditure (TEE) was estimated from REE and physical activity data. Kt was calculated from delivered (single-pool Kt/V)*Watson V. Kt/BSA, Kt/REE and Kt/TEE were then calculated at baseline and 6 monthly during follow-up for 2 years. Results In adjusted Cox models Kt/TEE, Kt/BSA, Kt/REE, in that order, had lower hazard ratios for death than single-pool Kt/V. On the basis of adjusted survival differences, putative minimum target doses were estimated for Kt/BSA as 27119 ml/m2 and Kt/TEE as 25.79 ml/kcal. We identified spKt/V values equivalent to these estimated targets, ranging from 1.4 to 1.8 in patient groups based on gender, body size and physical activity. For sedentary patients, the minimum target dose was 1.4 for large males, 1.5 for small males and 1.7 for women. For active patients the target was 1.8 irrespective of gender and body-weight. Patients achieving these individualised minimum targets had greater adjusted two-year survival compared to those achieving conventional minimum targets. Conclusions Metabolic activity related parameters, such as Kt/TEE and Kt/BSA, may have a clinically important role in scaling haemodialysis dose. Using such parameters or their spKt/V equivalents to adjust minimum target doses based on gender, body size and habitual physical activity may have a positive impact on survival.en_US
dc.language.isoenen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectHaemodialysis adequacyen_US
dc.subjectmetabolismen_US
dc.subjectenergy expenditureen_US
dc.subjectphysical activityen_US
dc.subjectsurvival analysisen_US
dc.titleIndexing Dialysis Dose for Gender, Body size and Physical Activity: Impact on Survivalen_US
dc.typeinfo:eu-repo/semantics/dataseten_US
dc.identifier.doi10.18745/DS.20285
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
herts.preservation.rarelyaccessedtrue


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