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Open AccessArticle

Predicting Residual Function in Hemodialysis and Hemodiafiltration—A Population Kinetic, Decision Analytic Approach

Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA
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J. Clin. Med. 2019, 8(12), 2080; https://doi.org/10.3390/jcm8122080
Received: 12 September 2019 / Revised: 16 November 2019 / Accepted: 18 November 2019 / Published: 29 November 2019
(This article belongs to the Section Nephrology & Urology)
In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of beta 2 microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations were derived entirely from computer simulations and advanced statistical modeling and had extremely high discrimination (Area Under the Curve, AUC 0.888–0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized predialysis and postdialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions for individualizing dialysis prescriptions in patients with preserved RRF.
Keywords: residual renal function; middle molecules; beta 2 microglobulin; cystatin c; population kinetic model; dialysis; simulator calibration framework; equation; biomarkers; urea clearance residual renal function; middle molecules; beta 2 microglobulin; cystatin c; population kinetic model; dialysis; simulator calibration framework; equation; biomarkers; urea clearance
MDPI and ACS Style

Achakzai, M.I.; Argyropoulos, C.; Roumelioti, M.-E. Predicting Residual Function in Hemodialysis and Hemodiafiltration—A Population Kinetic, Decision Analytic Approach. J. Clin. Med. 2019, 8, 2080.

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