Adequacy Panels

Ascend Clinical offers a variety of adequacy panels in LabCheck.
Adequacy Panels – DOWNLOAD
HEMODIALYSIS

Kt/V Jindal (Not K/DOQI Recommended)

  • Jindal calculation

  • Does not require draw information

  • Includes Pre BUN, Post BUN, URR, Kt/V Jindal

Kt/V Natural Log, URR

  • Daugirdas II calculation

  • Requires the following draw information (pre-weight, post-weight, treatment time)

  • Includes Pre BUN, Post BUN, URR, Kt/V Natural Log

  • CMS requirement for patients dialyzing 3 times per week

Kt/V Natural Log, URR, nPNA (3x/wk)

  • Daugirdas II and Depner calculations
  • Requires the following draw information (pre-weight, post-weight, treatment time, treatment number for nPNA calculation)

  • Includes Pre BUN, Post BUN, URR, Kt/V Natural Log, nPNA

  • nPNA calculated from Kt/V without formal kinetic modeling by Depner and Daugirdas using thrice-weekly dialysis

Kt/V Standard, Natural Log, URR

  • Leypoldt and Daugirdas II calculation

  • Requires the following draw information (pre-weight, post-weight, treatment time, number of treatments per week)

  • Includes Pre BUN, Post BUN, URR, Kt/V Standard and Kt/V Natural Log

  • CMS requirement for patients dialyzing 2 or 4-6 times per week

Kt/V Standard, URR (<>3x/wk)

  • Leypoldt calculation
  • Requires the following draw information (pre-weight, post-weight, treatment time, number of treatments per week)

  • Includes Pre BUN, Post BUN, URR, Kt/V Standard

  • CMS requirement for patients dialyzing 2 or 4-6 times per week (Measures Assessment Tool)

Kt/V Residual

  • Kt/V Residual calculated when Residual Urea Clearance ordered together with Kt/V Natural Log or Kt/V Standard; assesses total adequacy and is included on a patient report up to six months.

  • Requires draw information: 24-hr urine collection time, urine volume, dry weight, height

  • Includes Pre BUN, KrU, Urine Urea Nitrogen, Kt/V Residual

 

PERITONEAL DIALYSIS

PD Adequacy No Urine

  • Volume of Distribution (V): Hume and Weyers for Adult; Friis-Hansen for Peds <16 years 

  • Body Surface Area (BSA): Dubois and Dubois for Adult; Haycock for Peds <16 years

  • Protein Nitrogen Appearance (PNA): Bergstrom
  • Requires draw information (dry weight, height, 24-hr total drain volume)

  • Includes Blood BUN, Blood Creatinine, Fluid Glucose, Fluid Urea Nitrogen, Fluid Creatinine, Weekly Dialysate Kt/V, Weekly Dialysate CrCl, nPNA

PD Adequacy With Urine

  • Volume of Distribution (V): Hume and Weyers for Adult; Friis-Hansen for Peds <16 years 
  • Body Surface Area (BSA): Dubois and Dubois for Adult; Haycock for Peds <16 years

  • Protein Nitrogen Appearance (PNA): Bergstrom

  • Requires the following draw information (dry weight, height, total urine collection time, urine volume, 24-hr total drain volume)

  • Includes Blood BUN, Blood Creatinine, Fluid Glucose, Fluid Urea Nitrogen, Fluid Creatinine,Urine Urea Nitrogen,Urine Creatinine,Weekly Dialysate Kt/V, Weekly Residual Kt/V, Weekly TotalKt/V, Weekly Dialysate CrCl, Weekly Residual GFR, Weekly Total CrCl, Weekly Residual CrCl, and nPNA

FORMAL UREA KINETIC MODELING (UKM)

Formal Kinetic Modeling is also available in LabCheck for hemodialysis patients dialyzing 2-3 times per week. Per KDOQI, formal kinetic modeling provides a quantitative method for developing a treatment prescription for a specific patient. Formal UKM can be used to calculate the exact treatment time required to deliver a particular hemodialysis dose at specified blood and dialysate flows with a particular dialyzer.

RESOURCES

AJKD: https://www.ajkd.org/article/S0272-6386(15)01019-7/fulltext

CMS: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Dialysis.html

KDOQI: https://www.kidney.org/sites/default/files/docs/12-50-0210_jag_dcp_guidelines-hd_oct06_sectiona_ofc.pdf