Correlation between Dt/V derived from ionic dialysance and blood-driven Kt/V of urea in African-American hemodialysis patients, based on body weight and ultrafiltration volume

Background: The Dt/V obtained by using ionic dialysance (D) as a surrogate for urea clearance (K) is a well-validated adjunct measure of hemodialysis adequacy, with a variable level of correlation with urea-based Kt/V. However, this correlation has not been examined based on patients' body size and ultrafiltration (UF) volume during the dialysis session. Methods: Simultaneous evaluations of online Dt/V and single-pool variable-volume urea Kt/Vwere made. Patientswere categorized into three subgroups based on their weight (< 60, 60-80 and >= 80kg), bodymass index (< 25, 25-30 and> 30kg/m(2)) andUF volume (< 1.5, 1.5-3 and> 3L). The correlation between Dt/V and Kt/Vwas evaluated for the entire cohort per dialysis session in each subgroup. Results: Mean Kt/V was greater than themean Dt/V (1.72 versus 1.50, P< 0.001), with an overall correlation r value of 0.602. This correlation was stronger in the medium weight group versus lower and higher weights. The correlation between Dt/V and Kt/V was inversely related to the UF volume (r = 0.698, 0.621 and 0.558 for those with UF volume of <1.5, 1.5-3.0 and >3 L, respectively). A total of 99.3% of patients with Dt/V of > 1.2 also had Kt/V > 1.2 and 9.5% of those with Dt/V<1.2 had their Kt/V <1.2. Conclusions: There is a moderate degree of correlation between Dt/V and Kt/V in African-American hemodialysis patients, which is impacted by body size and UF volume. A Dt/V of >1.2 strongly predicts adequate dialysis as defined by Kt/V of >1.2.