Logarithmic extrapolation of a 15-minute postdialysis BUN to predict equilibrated BUN and calculate double-pool Kt/V in the pediatric hemodialysis population

Blood urea nitrogen (BUN) concentration rebounds logarithmically for 1 hour after a hemodialysis treatment. We have previously devised and evaluated an equilibrated Kt/V (eqKW) estimation method using logarithmic extrapolation of the BUN Increase from 30 seconds to 15 minutes postdialysis in six pediatric hemodialysis patients. The current study evaluates logarithmic extrapolation in 15 additional pediatric patients. Mean measured equilibrated BUN (eqBUN) and estimated BUN at equilibrium (estBUN) using logarithmic extrapolation were 23.1 ± 9.2 and 23.0 ± 9.4 mg/dL, respectively. The mean absolute difference between estBUN and eqBUN was 0.7 ± 0.4 mg/dL (range, 0.1 to 1.55 mg/dL). All treatments had an absolute difference less than the SD of the laboratory measurement itself. The mean absolute percentage of difference between eqKW using eqBUN and estimated double-pool equilibrated Kt/V (estKW) using estBUN from logarithmic extrapolation was 3.4% ± 2.3% and did not vary as a function of patient size, urea generation rate, dialyzer urea clearance, Kd/V, or ultrafiltration fraction. Mean absolute percentages of difference between eqKW and KW estimated by the Tattersall, Daugirdas, or Maduell formulas were 4.5% ± 3.9%, 4.4% ± 3.7%, and 6.7% ± 8.3%, respectively. Total percentages of error (absolute mean percentage of error + 2 SD) between eqKW and estKW by logarithmic extrapolation or the Tattersall, Daugirdas, or Maduell formulas were 8.0%, 12.3%, 11.8%, and 22.3%, respectively. The greater accuracy of logarithmic extrapolation compared with other methods of double-pool KW estimation held true for patients weighing less than 35 kg. We have validated the use of an easy and accurate method requiring only an additional 15-minute posttreatment BUN level to estimate double-pool KW in children.