Clinical outcome relative to the dose of dialysis is not what you think: the fallacy of the mean.

摘要: Several recent retrospective studies of mortality relative to the dose dialysis have been widely interpreted indicate that adequate thrice-weekly hemodialysis requires a single pool Kt/V (spKt/V) at least 1.4 1.6 and higher. In these studies, rate has correlated mean delivered spKt/V, (spKt/Vd)m, with coefficient variation (CV) on means ranging up 45%. To evaluate reported relationships, two large databases were analyzed using population constants transform urea reduction ratio spKt/Vd equilibrated Kt/Vd (eKt/Vd), which expresses corrected for treatment time. The eKt/V (D) values risks (RR) derive RR/D function. function, derived from data stepwise linear regression analysis, is nonlinear, steep increase in RR eKt/Vd less than 1.05 constant > or = 1.05. This function mathematically expressed as 1.96 - 1.03(eKt/Vd) (equation 1) when 0.50 We show (eKt/Vd)m CV results overestimation individual patients because extrapolation relationship beyond threshold where slope becomes zero (see equation 2 above). It concluded (1) current clinical provided 1.0 1.1 schedule, (2) it essential assure all achieve this level therapy, best accomplished kinetic modeling both prescription measurement eKt/Vd, (3) HEMO study well designed determine whether higher levels will further improve outcome.