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Some investigators have proposed dosing based on surface area (S) instead of V, but clinicians usually measure the URR and then calculate Kt/V. One can "adjust" the Kt/V, to calculate a "surface-area-normalized" or "SAN"-Kt/V as well as a "SAN"-standard Kt/V. This puts a wrapper around Kt/V and normalizes it to body surface area. [8]
Kt/V and standardized Kt/V are not the same. Kt/V is a ratio of the pre- and post-dialysis urea concentrations. Standardized Kt/V is an equivalent clearance defined by the initial urea concentration (compare equation 8 and equation 10). Kt/V is defined as (see article on Kt/V for derivation):
To use, take the single-pool Kt/V on the horizontal axis, move up to the isopleth (curve) corresponding to the number of sessions per week, and read the weekly ...
A more accurate relationship between URR and Kt/V can be derived by single-pool, variable volume urea kinetic modeling. A simplified estimating equation also can be used. [ 2 ] This gives results that are quite similar to formal urea modeling as long as dialysis treatments of 2–6 hours in duration are given, and Kt/V is between 0.7 and 2.0.
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The heavy green line shows the relation when UF/W - 0.03. So in practice, because of urea generation and UF/W, a 63% URR (0.63) results in a Kt/V of about 1.15 instead of only 1.0 (see graph). KDOQI hemodialysis adequacy standards are written in terms of either Kt/V or URR, with Kt/V being the preferred choices. But a patient may meet one ...
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